| Mid-south Health Clinic Llc | |
|
3100 Warrior Ln Poplar Bluff MO 63901-8686 | |
| (573) 785-0851 | |
| Not Available |
| Full Name | Mid-south Health Clinic Llc |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 3100 Warrior Ln, Poplar Bluff, Missouri |
| Authorized Official Name and Position | Joetta Martin (ADMINISTRATOR) |
| Authorized Official Contact | 5737850851 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid-south Health Clinic Llc 233 E Center Dr Alton IL 62002-5931 Ph: (618) 465-7717 | Mid-south Health Clinic Llc 3100 Warrior Ln Poplar Bluff MO 63901-8686 Ph: (573) 785-0851 |
| NPI Number | 1073595096 |
|---|---|
| Provider Enumeration Date | 11/16/2005 |
| Last Update Date | 07/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073595096 | NPI | - | NPPES |
| 598977007 | Medicaid | MO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | 031640 (Missouri) | Primary |
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