Provider Demographics
NPI:1598878845
Name:WELCH, VIRGINIA GALE
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:GALE
Last Name:WELCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2176 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2440
Mailing Address - Country:US
Mailing Address - Phone:573-686-0400
Mailing Address - Fax:573-686-0400
Practice Address - Street 1:2176 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2440
Practice Address - Country:US
Practice Address - Phone:573-686-0400
Practice Address - Fax:573-686-0400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5744200001Medicare NSC