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Organization

CHILDREN'S CLINIC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RANGSAN SUVAN M.D. (OWNER/PHYSICIAN)
(573) 686-2585
Entity
Organization

Contact information

Practice address
2500 LUCY LEE PKWY, POPLAR BLUFF, MO 63901-2436
(573) 686-2585
Mailing address
2500 LUCY LEE PKWY, POPLAR BLUFF, MO 63901-2436
(573) 686-2585

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
131252002
ARKANSAS GROUP MEDICAID
AR
Enumeration date
06/24/2008
Last updated
06/24/2008
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