Healthcare Provider Details

I. General information

NPI: 1205879426
Provider Name (Legal Business Name): POPLAR BLUFF REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HALS PLAZA
PIEDMONT MO
63957
US

IV. Provider business mailing address

1 HALS PLAZA
PIEDMONT MO
63957
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-5311
  • Fax:
Mailing address:
  • Phone: 573-686-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY PARRY
Title or Position: SR VP AND GENERAL COUNSEL
Credential: ESQ
Phone: 239-598-3176