Organization · Type 2 NPI

State of Missouri

Family Medicine Physician · Poplar Bluff, MO

NPI number 1740560580 Active

Practice location

2351 Kanell Blvd
Poplar Bluff, MO 63901-4035

Call (573) 840-9370 Map

Fax (573) 840-9373

Mailing address

PO Box 687
Jefferson City, MO 65102-0687

Specialties and licenses

Taxonomy	Code	License
Emergency Medicine Physician	207P00000X	None listed
Family Medicine Physician Primary	207Q00000X	None listed

Family Medicine Physician: Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

5 other providers at this address

Other family medicine physician providers in Poplar Bluff

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NPI record

NPI: 1740560580
Entity type: Organization (Type 2)
Issued: Aug 25, 2011
Last updated: Oct 15, 2020
Status: Active
Subpart: Yes of State of Missouri

Other names

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Southeast Missouri Residential Services-Poplar Bluff Prof GRP · doing business as
Southeast Missouri Residential Services-Poplar Bluff Prof GRP · doing business as

Authorized official

Molly Jane Boeckmann
Director of Administrative Services
(573) 751-4055

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1740560580

State of Missouri's National Provider Identifier is 1740560580, issued on Aug 25, 2011. The primary taxonomy on file is Family Medicine Physician (207Q00000X), and the practice location is in Poplar Bluff, MO. The record was last updated on Oct 15, 2020.