Provider Demographics
NPI:1881694685
Name:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Entity type:Organization
Organization Name:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-996-2141
Mailing Address - Street 1:109 PLUM ST
Mailing Address - Street 2:
Mailing Address - City:DONIPHAN
Mailing Address - State:MO
Mailing Address - Zip Code:63935-1277
Mailing Address - Country:US
Mailing Address - Phone:573-996-2141
Mailing Address - Fax:573-996-3949
Practice Address - Street 1:109 LEROUX DRIVE
Practice Address - Street 2:
Practice Address - City:DONIPHAN
Practice Address - State:MO
Practice Address - Zip Code:63935-1277
Practice Address - Country:US
Practice Address - Phone:573-996-2136
Practice Address - Fax:573-996-3105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-22
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
263450Medicare Oscar/Certification
MO263450Medicare Oscar/Certification