Organization
KNEIBERT CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E CHRISTIAN (ADMINISTRATOR)
(573) 778-7210
Entity
Organization
Contact information
Practice address
686 LESTER ST, POPLAR BLUFF, MO 63901
(573) 686-2411
(573) 686-8452
Mailing address
PO BOX 220, POPLAR BLUFF, MO 63902
(573) 686-2411
(573) 686-8452
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
2084P0800X
Psychiatry Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107927002
—
AR
05
—
500295407
—
MO
Enumeration date
01/04/2006
Last updated
03/22/2012
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