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Organization
POPLAR BLUFF PEDIATRIC ASSOC LL
Active
Organization
POPLAR BLUFF PEDIATRIC ASSOC LL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY L MOSS (OFFICE MANAGER)
(573) 785-2005
Entity
Organization
Contact information
Practice address
2210 BARRON RD, SUITE 120, POPLAR BLUFF, MO 63901-1908
(573) 785-2005
(573) 785-9444
Mailing address
2210 BARRON RD, SUITE 120, POPLAR BLUFF, MO 63901-1908
(573) 785-2005
(573) 785-9444
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
261Q00000X
Clinic/Center
—
NULL
261QR1300X
Rural Health Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/15/2007
Last updated
10/05/2017
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