Healthcare Provider Details

I. General information

NPI: 1841606860
Provider Name (Legal Business Name): POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 N DOUGLASS ST
MALDEN MO
63863-1512
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 573-276-3873
  • Fax: 573-276-2625
Mailing address:
  • Phone: 615-465-7000
  • Fax: 615-465-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES P WRIGHT
Title or Position: SR. DIRECTOR
Credential:
Phone: 615-465-7587