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Contact Information

SOUTHEAST MISSOURI STATE UNIVERSITY
1 UNIVERSITY PLZ # MS 0200
CAPE GIRARDEAU, MO63701-4710
 Phone: 972-367-4845
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

2081S0010X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for SOUTHEAST MISSOURI STATE UNIVERSITY

NPI # 1871003301
LBN Legal business name SOUTHEAST MISSOURI STATE UNIVERSITY
Authorized official MOUZON BASS - (AGENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/11/2017
Last updated 12/17/2021 - About 4 years ago
Identifiers
MO License # 2007008844
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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