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1407 N Westwood Blvd Poplar Bluff MO 63901-3315 | |
(573) 663-2313 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1407 N Westwood Blvd, Poplar Bluff, Missouri |
Authorized Official Name and Position | Karen White (CEO) |
Authorized Official Contact | 5736632313 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 157 Ellington MO 63638-0157 Ph: (573) 663-2313 | 1407 N Westwood Blvd Poplar Bluff MO 63901-3315 Ph: (573) 663-2313 |
NPI Number | 1811428402 |
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Provider Enumeration Date | 03/24/2017 |
Last Update Date | 06/20/2022 |
Medicare PECOS PAC ID | 6709871007 |
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Medicare Enrollment ID | O20170919001262 |
Identifier | Type | State | Issuer |
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1811428402 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Missouri) | Primary |
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