| |
930 N Westwood Blvd Poplar Bluff MO 63901-4242 | |
(573) 778-1620 | |
(573) 778-1486 |
Full Name | |
---|---|
Speciality | Family Medicine |
Location | 930 N Westwood Blvd, Poplar Bluff, Missouri |
Authorized Official Name and Position | Paula J Mcalister (ADMINISTRATOR) |
Authorized Official Contact | 5737781697 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
930 N Westwood Blvd Poplar Bluff MO 63901-4242 Ph: (573) 778-1620 | 930 N Westwood Blvd Poplar Bluff MO 63901-4242 Ph: (573) 778-1620 |
NPI Number | 1952550485 |
---|---|
Provider Enumeration Date | 09/09/2008 |
Last Update Date | 09/09/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1952550485 | NPI | - | NPPES |
164653 | Other | MO | BLUE CROSS BLUE SHIELD |
242613084 | Medicaid | MO | |
26D1003101 | Other | MO | CLIA |
000000E14668 | Other | MO | PREMIER BENEFITS |
915331 | Other | UNITED HEALTH CARE | |
P00109903 | Other | MO | MEDICARE RAILROAD |
1922003276 | Other | MO | INDIVIDUAL NPI |
242613073 | Medicaid | MO |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 36720 (Missouri) | Primary |
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