| Southeast Health Center Of Stoddard County Llc | |
|
1200 N One Mile Road Dexter MO 63841-1000 | |
| (573) 614-1900 | |
| (573) 624-8895 |
| Full Name | Southeast Health Center Of Stoddard County Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1200 N One Mile Road, Dexter, Missouri |
| Authorized Official Name and Position | Krista Berry (CFO) |
| Authorized Official Contact | 5733316028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Health Center Of Stoddard County Llc Po Box 368 Dexter MO 63841-1000 Ph: (573) 614-1900 | Southeast Health Center Of Stoddard County Llc 1200 N One Mile Road Dexter MO 63841-1000 Ph: (573) 614-1900 |
| NPI Number | 1477997567 |
|---|---|
| Provider Enumeration Date | 04/19/2013 |
| Last Update Date | 01/13/2024 |
| Medicare PECOS PAC ID | 7315192515 |
|---|---|
| Medicare Enrollment ID | O20130605000128 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477997567 | NPI | - | NPPES |
| Provider Name | Michael Lamb |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1104903582 PECOS PAC ID: 0648175125 Enrollment ID: I20031208000095 |
| Provider Name | Beth A Sjoblom |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558371781 PECOS PAC ID: 1355236001 Enrollment ID: I20040220000264 |
| Provider Name | Talia E Haiderzad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669572871 PECOS PAC ID: 4688563281 Enrollment ID: I20040312000048 |
| Provider Name | Marcus S Teng |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083724389 PECOS PAC ID: 5193718336 Enrollment ID: I20040405001220 |
| Provider Name | Lauren Denise Blackwelder |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194785394 PECOS PAC ID: 6406831999 Enrollment ID: I20040621000014 |
| Provider Name | Robert J Jibben |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043209836 PECOS PAC ID: 2466423728 Enrollment ID: I20040802001289 |
| Provider Name | Sherri J. Dobner |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1508973629 PECOS PAC ID: 2466427976 Enrollment ID: I20040828000174 |
| Provider Name | Jeffrey Tindall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043281694 PECOS PAC ID: 7315913175 Enrollment ID: I20040903000036 |
| Provider Name | John A Garcia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1649294554 PECOS PAC ID: 1254395361 Enrollment ID: I20041118000264 |
| Provider Name | Mayur S Ramesh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1043275167 PECOS PAC ID: 7012974066 Enrollment ID: I20041213000020 |
| Provider Name | Reza T Jalal |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578528618 PECOS PAC ID: 7911965066 Enrollment ID: I20041221000855 |
| Provider Name | Patience Onuoha |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649335092 PECOS PAC ID: 4587624291 Enrollment ID: I20050114000882 |
| Provider Name | Lei Guan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1235191321 PECOS PAC ID: 2961493176 Enrollment ID: I20050201000793 |
| Provider Name | Ashalatha Reddy Tatineny |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1760435648 PECOS PAC ID: 4688625668 Enrollment ID: I20050208000088 |
| Provider Name | Tammy S Fowler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1811086291 PECOS PAC ID: 0840246419 Enrollment ID: I20050328000015 |
| Provider Name | Jeremy M Daves |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1063513612 PECOS PAC ID: 0446299739 Enrollment ID: I20050426001343 |
| Provider Name | Mina Kay Massey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1578557872 PECOS PAC ID: 1052377876 Enrollment ID: I20050531000073 |
| Provider Name | Darwin L Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710942115 PECOS PAC ID: 5294724225 Enrollment ID: I20050801000319 |
| Provider Name | Mercy Sabapathypillai |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1013031426 PECOS PAC ID: 5193754075 Enrollment ID: I20050810001228 |
| Provider Name | Daud Y Khan |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1275582991 PECOS PAC ID: 1557394509 Enrollment ID: I20050912000548 |
| Provider Name | Donald G Foust |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1477532430 PECOS PAC ID: 1759300825 Enrollment ID: I20051117000516 |
| Provider Name | Cheryll Darline Rich |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538263827 PECOS PAC ID: 0941101612 Enrollment ID: I20060106000010 |
| Provider Name | Casey J Jason |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164459657 PECOS PAC ID: 8426028515 Enrollment ID: I20061116000519 |
| Provider Name | Andrew Hyatt |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1982667986 PECOS PAC ID: 4789609900 Enrollment ID: I20070126000252 |
| Provider Name | Aziz S Doumit |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801826847 PECOS PAC ID: 9436253853 Enrollment ID: I20070324000013 |
| Provider Name | Ronald Dean |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1437198074 PECOS PAC ID: 4385737865 Enrollment ID: I20070830000055 |
| Provider Name | Jennifer R Sellman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1649390683 PECOS PAC ID: 7315031333 Enrollment ID: I20070921000407 |
| Provider Name | Nilima P Chand |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1942227681 PECOS PAC ID: 6103729967 Enrollment ID: I20071107000718 |
| Provider Name | Syed M S Sayeed |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1619190162 PECOS PAC ID: 0840358289 Enrollment ID: I20081029000130 |
| Provider Name | Jennifer M Sadler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1295798510 PECOS PAC ID: 2062492523 Enrollment ID: I20090506000079 |
| Provider Name | Harmeeta Kaur Singh |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740481027 PECOS PAC ID: 8628120367 Enrollment ID: I20090710000288 |
| Provider Name | Rodney T Rubi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184727422 PECOS PAC ID: 8527109081 Enrollment ID: I20100105000725 |
| Provider Name | Wahied Adieb Gendi |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902093594 PECOS PAC ID: 9739224056 Enrollment ID: I20100310000847 |
| Provider Name | Philma B Opinaldo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023128840 PECOS PAC ID: 7719027127 Enrollment ID: I20100317000251 |
| Provider Name | Ronald Pearson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1831228782 PECOS PAC ID: 3779619937 Enrollment ID: I20100327000237 |
| Provider Name | Abdulrahman A Raja |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1861493363 PECOS PAC ID: 4587730056 Enrollment ID: I20100422000401 |
| Provider Name | Jack L Morgan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851387930 PECOS PAC ID: 0446295752 Enrollment ID: I20100605000033 |
| Provider Name | Carlos Rivas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942261052 PECOS PAC ID: 6507845666 Enrollment ID: I20100609000410 |
| Provider Name | William B Suk |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053428201 PECOS PAC ID: 6002811247 Enrollment ID: I20100717000134 |
| Provider Name | Philip K Sadler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1164484945 PECOS PAC ID: 2769453471 Enrollment ID: I20100818000907 |
| Provider Name | Meyyappan Palaniappan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508925553 PECOS PAC ID: 7719002948 Enrollment ID: I20100913000131 |
| Provider Name | Anthonia O Ekpenike |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659577484 PECOS PAC ID: 8426174814 Enrollment ID: I20100922000975 |
| Provider Name | Sherry Chessor |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689899635 PECOS PAC ID: 1557535960 Enrollment ID: I20111122000083 |
| Provider Name | Beverly Caruso |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1720112923 PECOS PAC ID: 6608817903 Enrollment ID: I20120823000927 |
| Provider Name | Natasha Ware |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083840433 PECOS PAC ID: 3072764521 Enrollment ID: I20121110000203 |
| Provider Name | Pavan N Palepu |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1851591614 PECOS PAC ID: 9436296068 Enrollment ID: I20121112000353 |
| Provider Name | Elliott Landfield |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1568417756 PECOS PAC ID: 4880652932 Enrollment ID: I20130926000579 |
| Provider Name | Venumadhav Chirunomula |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528292406 PECOS PAC ID: 8729238266 Enrollment ID: I20140109000517 |
| Provider Name | Walter Turkowski |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396749727 PECOS PAC ID: 4183722150 Enrollment ID: I20140303001309 |
| Provider Name | Daniel W Ross |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538163506 PECOS PAC ID: 9931003696 Enrollment ID: I20140425000898 |
| Provider Name | John A Eppolito |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083790083 PECOS PAC ID: 1759303365 Enrollment ID: I20150213001672 |
| Provider Name | Kevin W Lovette |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619384088 PECOS PAC ID: 3072838069 Enrollment ID: I20150216000799 |
| Provider Name | Sergey Sorin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962484121 PECOS PAC ID: 1254383987 Enrollment ID: I20161018001880 |
| Provider Name | Aneesuddin S Hashmi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164464962 PECOS PAC ID: 9830369602 Enrollment ID: I20161026001148 |
| Provider Name | Irais Leon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528059219 PECOS PAC ID: 3274546544 Enrollment ID: I20161111000886 |
| Provider Name | Christy L Walter |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801859160 PECOS PAC ID: 2062479504 Enrollment ID: I20170615000352 |
| Provider Name | Andres F Velasco |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942351861 PECOS PAC ID: 9335153303 Enrollment ID: I20170714002528 |
| Provider Name | Lauren Virginia C Miller |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1033555891 PECOS PAC ID: 8022311695 Enrollment ID: I20170825001673 |
| Provider Name | Kamal Kumar Goyal |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043698111 PECOS PAC ID: 5890065981 Enrollment ID: I20180205001109 |
| Provider Name | Jefferydon Lee Coon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376834101 PECOS PAC ID: 4981995370 Enrollment ID: I20180413001527 |
| Provider Name | Drew Zural Satterfield |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1316328735 PECOS PAC ID: 7517279193 Enrollment ID: I20180807000363 |
| Provider Name | Kerri R Lynch |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013493865 PECOS PAC ID: 7416207337 Enrollment ID: I20180913001604 |
| Provider Name | Seth Tyler Koehler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1255782843 PECOS PAC ID: 3577854108 Enrollment ID: I20181203000133 |
| Provider Name | Kristin Guethle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255801247 PECOS PAC ID: 1254679038 Enrollment ID: I20190221001046 |
| Provider Name | Meagan Ward |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295238681 PECOS PAC ID: 8628319423 Enrollment ID: I20190404000274 |
| Provider Name | Sierra Elaine Holiman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558924845 PECOS PAC ID: 0042544074 Enrollment ID: I20190625004057 |
| Provider Name | Brian Paul Duffell |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1629426978 PECOS PAC ID: 9335499409 Enrollment ID: I20190807002276 |
| Provider Name | Sajjad Ali |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851742092 PECOS PAC ID: 2961798236 Enrollment ID: I20191021000375 |
| Provider Name | Gift Eze |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457384588 PECOS PAC ID: 8224017736 Enrollment ID: I20200423001695 |
| Provider Name | Gianluca Cerri |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1922157627 PECOS PAC ID: 5395642193 Enrollment ID: I20200611000977 |
| Provider Name | Chibuike Anokwute |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669731741 PECOS PAC ID: 1658683370 Enrollment ID: I20201218000519 |
| Provider Name | Edward Reese |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1013279918 PECOS PAC ID: 5395969323 Enrollment ID: I20210518000780 |
| Provider Name | Jelaina Nicole Scott |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366975922 PECOS PAC ID: 9234460957 Enrollment ID: I20210519000588 |
| Provider Name | Gilbert Shawn Duxbury |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1508014044 PECOS PAC ID: 7719133198 Enrollment ID: I20210716000257 |
| Provider Name | Jessica Rene Yeley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912595547 PECOS PAC ID: 9436547494 Enrollment ID: I20211022002337 |
| Provider Name | Frank A Furnari |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083176929 PECOS PAC ID: 4284017377 Enrollment ID: I20220823002181 |
| Provider Name | John L Starwalt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780146662 PECOS PAC ID: 6103201165 Enrollment ID: I20220913000377 |
| Provider Name | Jennetta Sue Stearns |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356061121 PECOS PAC ID: 5395112171 Enrollment ID: I20221108001286 |
| Provider Name | Samantha L Karmas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487367694 PECOS PAC ID: 0345613998 Enrollment ID: I20230301000408 |
| Provider Name | Ashley M Gantner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245959717 PECOS PAC ID: 4082089065 Enrollment ID: I20230404002318 |
| Provider Name | Yelena A Krishchenko |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750736450 PECOS PAC ID: 4981089885 Enrollment ID: I20230427000870 |
| Provider Name | Melissa E Hubbard |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295423077 PECOS PAC ID: 7517325046 Enrollment ID: I20230615001471 |
Stoddard County Family Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1300 N One Mile Rd, Dexter, MO 63841 Phone: 573-624-1640 | |
Davis Health & Wellness Clinic, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 808 Speciality Dr Ste A, Dexter, MO 63841 Phone: 573-891-1250 Fax: 573-891-1320 | |
Practice Tee, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1523 W Business Hwy 60, Dexter, MO 63841 Phone: 573-624-8447 | |
Dexter Hospital Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2025 W Bus Hwy 60, Dexter, MO 63841 Phone: 573-624-7575 Fax: 573-624-6399 | |
Southeast Health Center Of Stoddard County, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 2025 W Business Us Highway 60, Dexter, MO 63841 Phone: 573-614-4600 Fax: 573-614-4606 | |
Dexter Hosptial Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1300 N One Mile Rd, Suite 1, Dexter, MO 63841 Phone: 573-624-7788 |