Organization
PLUNKETT FAMILY CARE CENTER LLC
Active
Parent organization
PLUNKETT FAMILY CARE CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
PLUNKETT FAMILY CARE CENTER LLC
Authorized official
KATHY A HAAS (OFFICE MANAGER)
(573) 686-5564
Entity
Organization
Contact information
Practice address
2480 THREE RIVERS BLVD, POPLAR BLUFF, MO 63901-2318
(573) 686-5564
(573) 686-2838
Mailing address
2480 THREE RIVERS BLVD, POPLAR BLUFF, MO 63901-2318
(573) 686-5564
(573) 686-2838
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
R3284
MO
261QP2300X
Primary Care Clinic/Center
Primary
R3284
MO
363LF0000X
Family Nurse Practitioner
089729
MO
363LF0000X
Family Nurse Practitioner
143295
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA1473
RAILROAD MEDICARE
—
Enumeration date
11/29/2007
Last updated
11/29/2007
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