# DOROTHY M. MUNCH, D.O., LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Poplar Bluff Wellness Clinic
- **Organization subpart:** No

## Provider details

- **NPI number:** 1952550485
- **Authorized official:** MRS. PAULA J MCALISTER BSHA/LTC (ADMINISTRATOR)
- **Authorized official phone:** (573) 778-1697

## Contact information

- **Practice address:** 930 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-4242
- **Practice address phone:** (573) 778-1620
- **Practice address fax:** (573) 778-1486
- **Mailing address:** 930 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-4242
- **Mailing address phone:** (573) 778-1620
- **Mailing address fax:** (573) 778-1486

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 36720 | MO | Yes |

## Other

- **Enumeration date:** 09/09/2008
- **Last updated:** 09/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000E14668 | PREMIER BENEFITS | MO |
| 01 | — | 164653 | BLUE CROSS BLUE SHIELD | MO |
| 01 | — | 1922003276 | INDIVIDUAL NPI | MO |
| 05 | — | 242613073 | — | MO |
| 05 | — | 242613084 | — | MO |
| 01 | — | 26D1003101 | CLIA | MO |
| 01 | — | 915331 | UNITED HEALTH CARE | — |
| 01 | — | P00109903 | MEDICARE RAILROAD | MO |