| Elite Obstetrics And Gynecology Llc | |
|
225 Physicians Park Ste 305 Poplar Bluff MO 63901-3935 | |
| (573) 772-4340 | |
| Not Available |
| Full Name | Elite Obstetrics And Gynecology Llc |
|---|---|
| Speciality | Obstetrics & Gynecology |
| Location | 225 Physicians Park Ste 305, Poplar Bluff, Missouri |
| Authorized Official Name and Position | Tracy Gibbs (MANAGING DIRECTOR) |
| Authorized Official Contact | 6367515598 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Elite Obstetrics And Gynecology Llc Po Box 334 Van Buren MO 63965-0334 Ph: () - | Elite Obstetrics And Gynecology Llc 225 Physicians Park Ste 305 Poplar Bluff MO 63901-3935 Ph: (573) 772-4340 |
| NPI Number | 1538915210 |
|---|---|
| Provider Enumeration Date | 04/24/2024 |
| Last Update Date | 05/06/2024 |
| Medicare PECOS PAC ID | 5193264315 |
|---|---|
| Medicare Enrollment ID | O20240830002897 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538915210 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 207V00000X | Obstetrics & Gynecology | (* (Not Available)) | Primary |
| Provider Name | Farrah T Mcspadden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1205053758 PECOS PAC ID: 8921146168 Enrollment ID: I20091110000112 |
| Provider Name | Jody Beth Spain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427364744 PECOS PAC ID: 3678766466 Enrollment ID: I20101025001350 |
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