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OTTO BEAN MEDICAL CENTER
NPI 1710108766
Clinic/Center - Federally Qualified Health Center (FQHC) in Kennett, MO

Active since May 01, 2007CLIA 26D0924445 · Waiver
500 RUSSELL ST, KENNETT, MO 63857(573) 717-1332(573) 717-1335 Get Directions Write a Review

NPPES record last updated: April 14, 2020. Verified against the NPPES registry weekly; last sync: August 23, 2026.

About Otto Bean Medical Center NPPES

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

OTTO BEAN MEDICAL CENTER (NPI 1710108766) is a healthcare organization registered as a federally qualified health center (fqhc) in Kennett, Missouri and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through September 25, 2027 and lists Sara Deane, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1710108766
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameSOUTHEAST MISSOURI HEALTH NETWORK
Location Address500 RUSSELL STKennett, MO 63857-2102
Mailing Address6738 State Highway 77Benton, MO 63736-8238 · (573) 313-2500 · Fax (573) 313-2505
Phone(573) 717-1332
Fax(573) 717-1335
Organization SubpartNo
Authorized OfficialSara DeaneChief Financial Officer · (573) 313-2500
Enumeration DateMay 1, 2007
Last NPPES UpdateApril 14, 2020
NPPES CertifiedApril 14, 2020
✔ NPI 1710108766 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
500 RUSSELL ST, Kennett, MO 63857
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Other Names 2

Doing Business AsOtto Bean Medical Center
Other NameOtto Bean Medical Clinic

Other Identifiers 1

Medicaid500704036MO

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 26D0924445

Otto Bean Medical Center · Kennett, MO
Active · expires Sep 25, 2027
CLIA Number26D0924445
Laboratory TypePhysician Office
Certificate Effective DateSeptember 26, 2025
Certificate Expiration DateSeptember 25, 2027
Laboratory DirectorDaniel Domjan
Laboratory Phone(573) 717-1332
Laboratory LocationOtto Bean Medical Center500 Russell Street, Kennett, MO 63857
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.

SOUTHEAST MISSOURI HEALTH NETWORK
Dentist (General Practice)
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 888-3000
MS. TINA L CARTER LCSW
Social Worker (Clinical)
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 717-1332
JUDITH HAGGARD FNP
Nurse Practitioner
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 717-1332
MRS. DELAYNA MICHELE HUNTER FNP-C
Nurse Practitioner (Family)
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 717-1332
VALERIE A SMITH M.D.
Family Medicine
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 717-1332
MRS. AUTUMN LYNNETTE ALLGOOD FNP-C
Nurse Practitioner (Family)
500 RUSSELL ST
KENNETT, MO 63857
Dunklin County (573) 717-1332

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 1710108766. It was assigned to this organization in the NPPES registry on May 1, 2007. The provider is doing business as Otto Bean Medical Center. The provider is also known as Otto Bean Medical Clinic.

Where is Southeast Missouri Health Network located?

Southeast Missouri Health Network is located at 500 Russell St, Kennett, MO 63857. The listed phone number is (573) 717-1332.

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 26D0924445) is associated with this NPI, valid through September 25, 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.