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General NPI Number Information
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NPI Number | 1578894515
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Entity Type | Organization
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Legal Business Name | WESTWOOD MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 01/14/2010
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Last Update Date | 01/14/2010
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Provider Practice Location Address
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Address Line | 1919 BIG BEND RD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2813
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Country | US
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Telephone | 573-686-7223
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Fax | 573-686-7224
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Provider Business Mailing Address
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Address Line | 1919 BIG BEND RD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2813
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Country | US
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Telephone | 573-686-7223
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Fax | 573-686-7224
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHUL KIM
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Credential | M.D.
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Telephone | 573-686-7223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R8374
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License Number State | MO
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