Organization
POPLAR BLUFF MEDICAL PARTNERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL BURCHAM MBA (PRESIDENT, CEO)
(573) 727-9080
Entity
Organization
Contact information
Practice address
221 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 727-9080
(573) 686-1245
Mailing address
221 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 727-9080
(573) 686-1245
Taxonomy
Speciality
Code
Description
License number
State
261QM1200X
Magnetic Resonance Imaging (MRI) Clinic/Center
NOT REQUIRED
MO
261QR0200X
Radiology Clinic/Center
Primary
NOT REQUIRED
MO
261QR0206X
Mammography Clinic/Center
NOT REQUIRED
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
710426909
—
MO
Enumeration date
10/20/2005
Last updated
05/27/2008
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