SOUTHEAST MISSOURI SURGERY CENTER LLC – NPI #1164388021
Clinic/Center

SOUTHEAST MISSOURI SURGERY CENTER LLC is an AHC clinic located in CAPE GIRARDEAU, MO. NPPES has assigned the NPI number 1164388021 to SOUTHEAST MISSOURI SURGERY CENTER LLC on January 05, 2026. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was last updated on Feb 28, 2026. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHEAST MISSOURI SURGERY CENTER LLC below.

NPI Profile for
SOUTHEAST MISSOURI SURGERY CENTER LLC

NPI Number
1164388021
Enumeration Date

(about 5 months ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
SOUTHEAST MISSOURI SURGERY CENTER LLC
Primary location
65 DOCTORS PARK STE B
CAPE GIRARDEAU, MO 63703-4927
Phone: (573) 803-2420 Fax: (573) 651-8734
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
SONJAY FONN
OWNER/CEO
Phone: (573) 270-8365
Updated
Certification Date
Feb 28, 2026

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.