Organization
MID-SOUTH HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOETTA MARTIN (ADMINISTRATOR)
(573) 785-0851
Entity
Organization
Contact information
Practice address
3100 WARRIOR LN, POPLAR BLUFF, MO 63901-8686
(573) 785-0851
Mailing address
233 E CENTER DR, ALTON, IL 62002-5931
(618) 465-7717
(618) 465-7710
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
031640
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
598977007
—
MO
Enumeration date
11/16/2005
Last updated
07/10/2008
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