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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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