# MID-SOUTH HEALTH CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073595096
- **Authorized official:** JOETTA MARTIN (ADMINISTRATOR)
- **Authorized official phone:** (573) 785-0851

## Contact information

- **Practice address:** 3100 WARRIOR LN, POPLAR BLUFF, MO 63901-8686
- **Practice address phone:** (573) 785-0851
- **Mailing address:** 233 E CENTER DR, ALTON, IL 62002-5931
- **Mailing address phone:** (618) 465-7717
- **Mailing address fax:** (618) 465-7710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 031640 | MO | Yes |

## Other

- **Enumeration date:** 11/16/2005
- **Last updated:** 07/10/2008