Provider Demographics
NPI:1245477579
Name:BIG SPRINGS MEDICAL ASSOCIATION
Entity type:Organization
Organization Name:BIG SPRINGS MEDICAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC,PCA,CPC-H,CCP,CC
Authorized Official - Phone:573-663-2313
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ELLINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63638-0157
Mailing Address - Country:US
Mailing Address - Phone:573-663-2313
Mailing Address - Fax:573-663-2322
Practice Address - Street 1:3001 WARRIOR LN
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-8685
Practice Address - Country:US
Practice Address - Phone:573-785-7453
Practice Address - Fax:573-785-7429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIG SPRINGS MEDICAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000010497OtherSTATE MEDICARE
MO1245477579Medicaid
MO261028Medicare Oscar/Certification