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3100 Oak Grove Rd. Poplar Bluff MO 63901 | |
| (573) 686-5311 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | General Acute Care Hospital |
| Location | 3100 Oak Grove Rd., Poplar Bluff, Missouri |
| Authorized Official Name and Position | Paula Lalor (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Contact | 6292153953 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
3100 Oak Grove Rd Poplar Bluff MO 63901-1573 Ph: (573) 712-2546 | 3100 Oak Grove Rd. Poplar Bluff MO 63901 Ph: (573) 686-5311 |
| NPI Number | 1700831724 |
|---|---|
| Provider Enumeration Date | 05/24/2006 |
| Last Update Date | 04/20/2021 |
| Certification Date | 04/20/2021 |
| Medicare PECOS PAC ID | 6800707225 |
|---|---|
| Medicare Enrollment ID | O20030909000031 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700831724 | NPI | - | NPPES |
| 541602504 | Medicaid | MO | |
| 61 | Other | MO | BLUE CROSS |
| 011602505 | Medicaid | MO |
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