# POPLAR BLUFF PEDIATRIC ASSOC LL

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

## Provider details

- **NPI number:** 1275676355
- **Authorized official:** MRS. TIFFANY L MOSS (OFFICE MANAGER)
- **Authorized official phone:** (573) 785-2005

## Contact information

- **Practice address:** 2210 BARRON RD, SUITE 120, POPLAR BLUFF, MO 63901-1908
- **Practice address phone:** (573) 785-2005
- **Practice address fax:** (573) 785-9444
- **Mailing address:** 2210 BARRON RD, SUITE 120, POPLAR BLUFF, MO 63901-1908
- **Mailing address phone:** (573) 785-2005
- **Mailing address fax:** (573) 785-9444

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/15/2007
- **Last updated:** 10/05/2017