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General NPI Number Information
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NPI Number | 1568503357
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Entity Type | Organization
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Legal Business Name | POPLAR BLUFF REGIONAL MEDICAL CENTER, INC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 2620 N WESTWOOD BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-3396
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Country | US
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Telephone | 573-785-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 LACKLAND HILL PKWY
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City | SAINT LOUIS
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State | MO
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Zip | 63146-3572
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Country | US
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Telephone | 314-989-0300
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MR. JOHN ERIKSON
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Credential |
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Telephone | 573-785-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | R7892
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License Number State | MO
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