Portageville Family Clinic

LBN: Southeast Missouri Health Network
Portageville Family Clinic is an health care organization with primary practice located at 314 E Main St , Portageville MO 63873-1616. The organization recently has only one registered license in Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), which is considered as the primary health care specialty. Southeast Missouri Health Network can be contacted via phone (573) 379-5929, or through White, Cheryl A via phone (573) 748-2404.

Contact Information

Primary practice address
314 E Main St Portageville MO 63873-1616
Phone: (573) 379-5929
Fax: (573) 379-5912
Website:
Map and Directions
Authorized official contact:
Name: White, Cheryl A
Phone: (573) 748-2404

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1780803916
LBN Legal business name Southeast Missouri Health Network
DBA Doing business as Portageville Family Clinic
Authorized official White, Cheryl A
Entity Organization
Organization subpart 1 Yes
Enumeration date Apr 25th, 2007
Last updated Mar 7th, 2011 - about 14 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780803916 NPPES
Missouri Other 000010626 GROUP PTAN
Missouri MEDICAID 503973901 GROUP PTAN

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