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SOUTHEASTHEALTH
NPI 1053659904
Family Medicine in Poplar Bluff, MO

Active since January 28, 2013
2002 KANELL BLVD, POPLAR BLUFF, MO 63901(573) 778-0020(573) 776-7548 Get Directions Write a Review

NPPES record last updated: March 4, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Southeasthealth NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEASTHEALTH (NPI 1053659904) is a healthcare organization registered as a family medicine in Poplar Bluff, Missouri and active in the NPI registry since January 2013. The organization lists Paula E Harris, Vp Regional Operations, as its authorized official.

NPPES Registry Identity

NPI1053659904
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSOUTHEASTHEALTH HOSPITAL HOLDINGS, LLC
Location Address2002 KANELL BLVDPoplar Bluff, MO 63901-4045
Mailing AddressPo Box 989Poplar Bluff, MO 63902-0989 · (573) 778-0020 · Fax (573) 776-7548
Phone(573) 778-0020
Fax(573) 776-7548
Organization SubpartNo
Authorized OfficialPaula E HarrisVp Regional Operations · (573) 778-0020
Enumeration DateJanuary 28, 2013
Last NPPES UpdateMarch 4, 2013
✔ NPI 1053659904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedPodiatrist · Foot & Ankle SurgeryTaxonomy 213ES0103X
Also ListedNurse PractitionerTaxonomy 363L00000X
2002 KANELL BLVD, Poplar Bluff, MO 63901
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Other Names 1

Doing Business AsSoutheasthealth

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D1057142

Southeast Health-Poplar Bluff · Poplar Bluff, MO
Expired · Jul 31, 2026
CLIA Number26D1057142
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateAugust 1, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorLauren E. Thomas
Laboratory Phone(573) 712-2309
Laboratory LocationSoutheast Health-Poplar Bluff2002 Kanell Blvd 105, Poplar Bluff, MO 63901
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ROBERT C YOUNG, MD, FACOG
Obstetrics & Gynecology
2002 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 785-9864
ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Clinic/Center
2002 KANELL BLVD, SUITE 101
POPLAR BLUFF, MO 63901
Butler County (573) 778-9292
ROBERT C YOUNG
Obstetrics & Gynecology
2002 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 785-9864
ADVANCED HEALTH CARE MANAGEMENT SERVICES, LLC
Clinic/Center (Podiatric)
2002 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 785-4959
SOUTHEAST HEALTH PHARMACY LLC
Pharmacy (Community/Retail Pharmacy)
2002 KANELL BLVD, STE 102
POPLAR BLUFF, MO 63901
Butler County (573) 778-1608
ADVANCED HEALTHCARE MANAGEMENT SERVICES, LLC
Pharmacy (Community/Retail Pharmacy)
2002 KANELL BLVD, SUITE 102
POPLAR BLUFF, MO 63901
Butler County (573) 778-1608
DR. ZACKWRIE S PARR D.P.M.
Podiatrist (Foot & Ankle Surgery)
2002 KANELL BLVD, SUITE 201
POPLAR BLUFF, MO 63901
Butler County (573) 785-4959
GARY LUTHER WARD II D.O.
Family Medicine
2002 KANELL BLVD, SUITE 106
POPLAR BLUFF, MO 63901
Butler County (573) 712-2546

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Southeasthealth Hospital Holdings, LLC's NPI number?

The NPI number for Southeasthealth Hospital Holdings, LLC is 1053659904. It was assigned to this organization in the NPPES registry on January 28, 2013. The provider is doing business as Southeasthealth.

Where is Southeasthealth Hospital Holdings, LLC located?

Southeasthealth Hospital Holdings, LLC is located at 2002 Kanell Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 778-0020.

What is Southeasthealth Hospital Holdings, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

What insurance does Southeasthealth Hospital Holdings, LLC accept?

Health plans from Anthem Blue Cross and Blue Shield list Southeasthealth Hospital Holdings, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Southeasthealth Hospital Holdings, LLC was last updated on March 4, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.