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SIKESTON MEDICAL CENTER
NPI 1104045475
Clinic/Center - Federally Qualified Health Center (FQHC) in Sikeston, MO

Active since April 25, 2007CLIA 26D0687481 · Waiver
200 SOUTHLAND DR, SIKESTON, MO 63801(573) 472-1770(573) 472-4050 Get Directions Write a Review

NPPES record last updated: April 14, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Sikeston Medical Center NPPES

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

SIKESTON MEDICAL CENTER (NPI 1104045475) is a healthcare organization registered as a federally qualified health center (fqhc) in Sikeston, Missouri and active in the NPI registry since April 2007. The organization holds a CLIA Waiver certificate valid through March 30, 2027 and lists Sara Deane, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1104045475
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameSOUTHEAST MISSOURI HEALTH NETWORK
Location Address200 SOUTHLAND DRSikeston, MO 63801-4403
Mailing Address6738 State Highway 77Benton, MO 63736-8238 · (573) 313-2500 · Fax (573) 313-2505
Phone(573) 472-1770
Fax(573) 472-4050
Organization SubpartNo
Authorized OfficialSara DeaneChief Financial Officer · (573) 313-2500
Enumeration DateApril 25, 2007
Last NPPES UpdateApril 14, 2020
NPPES CertifiedApril 14, 2020
✔ NPI 1104045475 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
200 SOUTHLAND DR, Sikeston, MO 63801
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Other Names 1

Other NameSikeston Medical Center

Other Identifiers 1

Medicaid500704028MO

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Sunflower Health Plan and more.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 26D0687481

Southeast Missouri Health Network · Sikeston, MO
Active · expires Mar 30, 2027
CLIA Number26D0687481
Laboratory TypePhysician Office
Certificate Effective DateMarch 31, 2025
Certificate Expiration DateMarch 30, 2027
Laboratory DirectorDaniel Domjan
Laboratory Phone(573) 472-1770
Laboratory LocationSoutheast Missouri Health Network200 Southland Drive, Sikeston, MO 63801
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

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

DANIELLE E JANSEN FNP
Nurse Practitioner (Family)
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 472-1770
MRS. HEATHER ELIZABETH POLK APRN
Nurse Practitioner (Primary Care)
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 472-1770
DR. DANIEL DOMJAN MD
General Practice
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 472-1770
ALEXANDRA TOMASZEWSKI LCSW
Social Worker (Clinical)
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 472-1770
WILLIAM BRADLEY FNP
Nurse Practitioner (Family)
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 427-1770
SAMANTHA ANNE DUFFEL LCSW
Social Worker (Clinical)
200 SOUTHLAND DR
SIKESTON, MO 63801
Scott County (573) 472-1770

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 Southeast Missouri Health Network's NPI number?

The NPI number for Southeast Missouri Health Network is 1104045475. It was assigned to this organization in the NPPES registry on April 25, 2007. The provider is also known as Sikeston Medical Center.

Where is Southeast Missouri Health Network located?

Southeast Missouri Health Network is located at 200 Southland Dr, Sikeston, MO 63801. The listed phone number is (573) 472-1770.

What is Southeast Missouri Health Network's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Southeast Missouri Health Network hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D0687481) is associated with this NPI, valid through March 30, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Southeast Missouri Health Network accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and Ambetter from Sunflower Health Plan and 3 other insurers list Southeast Missouri Health Network 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 Southeast Missouri Health Network was last updated on April 14, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.