Provider Demographics
NPI:1376514794
Name:POPLAR PODIATRY P.C
Entity Type:Organization
Organization Name:POPLAR PODIATRY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-531-6924
Mailing Address - Street 1:228 W TYLER AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-4089
Mailing Address - Country:US
Mailing Address - Phone:870-735-6500
Mailing Address - Fax:
Practice Address - Street 1:228 W TYLER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-4089
Practice Address - Country:US
Practice Address - Phone:870-735-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118594748Medicaid
ARCJ8182OtherMEDICARE ID TYPE UNSPECIFIED
AR118594748Medicaid
ARCJ8182OtherMEDICARE ID TYPE UNSPECIFIED