Healthcare Provider Details

I. General information

NPI: 1962408187
Provider Name (Legal Business Name): POPLAR BLUFF REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 W PINE ST
POPLAR BLUFF MO
63901-5042
US

IV. Provider business mailing address

2620 N WESTWOOD BLVD
POPLAR BLUFF MO
63901-3396
US

V. Phone/Fax

Practice location:
  • Phone: 573-686-8144
  • Fax: 573-686-8147
Mailing address:
  • Phone: 573-686-8144
  • Fax: 573-686-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number751-1
License Number StateMO

VIII. Authorized Official

Name: TIMOTHY PARRY
Title or Position: SR. VP AND GENERAL COUNSEL
Credential: ESQ
Phone: 239-594-7368