Organization · Type 2 NPI

Southeast Missouri Health Network

Federally Qualified Health Center (FQHC) · Portageville, MO

NPI number 1780803916 Active

Practice location

314 E Main St
Portageville, MO 63873-1616

Call (573) 379-5929 Map

Fax (573) 379-5912

Mailing address

311 Main St, P.o. Box 400
New Madrid, MO 63869-1942

Specialties and licenses

Taxonomy	Code	License
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

4 other providers at this address

Health Facilities Rehab Services IncRehabilitation Clinic/Center Portageville, MO NPI 1194093526
Pemiscot County Memorial HospitalRural Health Clinic/Center Portageville, MO NPI 1699873372
Dennis Reed, PAPhysician Assistant Portageville, MO NPI 1629115670
Ralph Kelley, DOAdult Medicine Physician Portageville, MO NPI 1669589677

NPI record

NPI: 1780803916
Entity type: Organization (Type 2)
Issued: Apr 25, 2007
Last updated: Mar 7, 2011
Status: Active
Subpart: Yes of Southeast Missouri Health Network

Other names

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Portageville Family Clinic · doing business as

Authorized official

Cheryl A White
Chief Executive Officer
(573) 748-2404

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1780803916

Southeast Missouri Health Network's National Provider Identifier is 1780803916, issued on Apr 25, 2007. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Portageville, MO. The record was last updated on Mar 7, 2011.