MEDICARE: POPLAR BLUFF MEDICAL PARTNERS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center	NOT REQUIRED	MO
2	261QR0206X	Mammography Clinic/Center	NOT REQUIRED	MO
3	261QR0200X	Radiology Clinic/Center	NOT REQUIRED	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407845472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPLAR BLUFF MEDICAL PARTNERS, LLC

Provider Business Mailing Address
First Line	:	221 PHYSICIANS PARK
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3956
Country	:	US
Telephone Number	:	573-727-9080
Fax Number	:	573-686-1245

Provider Business Practice Location Address
First Line	:	221 PHYSICIANS PARK
Second Line	:
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-3956
Country	:	US
Telephone Number	:	573-727-9080
Fax Number	:	573-686-1245

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MR. MICHAEL BURCHAM
Credential	:	MBA
Telephone Number	:	573-727-9080

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	05/27/2008

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