# MIDWEST OB GYN OF MISSOURI, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDWEST OB GYN OF MISSOURI, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1396337473
- **Legal business name:** MIDWEST OB GYN OF MISSOURI, LLC
- **Authorized official:** JOHN R PATTY DO (OWNER/PHYSICIAN)
- **Authorized official phone:** (573) 772-7000

## Contact information

- **Practice address:** 2210 BARRON RD STE 206, POPLAR BLUFF, MO 63901-1908
- **Practice address phone:** (573) 772-7000
- **Mailing address:** PO BOX 1007, POPLAR BLUFF, MO 63902-1007
- **Mailing address phone:** (573) 772-7000
- **Mailing address fax:** (573) 686-1315

## Taxonomy

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

## Other

- **Enumeration date:** 02/09/2021
- **Last updated:** 03/05/2021