Provider Demographics
NPI:1932515954
Name:POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Other - Org Name:POPLAR BLUFF PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7587
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7000
Mailing Address - Fax:615-465-3007
Practice Address - Street 1:2360 KATY LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2300
Practice Address - Country:US
Practice Address - Phone:573-712-2546
Practice Address - Fax:573-712-2549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POPLAR BLUFF REGIONAL MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-10
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty