# POPLAR BLUFF PEDIATRIC ASSOC LL

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

## Provider details

- **NPI number:** 1457881963
- **Authorized official:** TIFFANY L MOSS (OFFICE MANAGER)
- **Authorized official phone:** (573) 785-2005

## Contact information

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

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 06/16/2017
- **Last updated:** 07/21/2022