| Poplar Bluff Regional Medical Center, Llc | |
|
130 E Harbin Ave Puxico MO 63960-9104 | |
| (573) 222-3556 | |
| (573) 222-3127 |
| Full Name | Poplar Bluff Regional Medical Center, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 130 E Harbin Ave, Puxico, Missouri |
| Authorized Official Name and Position | James P Wright (SR. DIRECTOR) |
| Authorized Official Contact | 6154657587 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Poplar Bluff Regional Medical Center, Llc Po Box 689022 Franklin TN 37068-9022 Ph: (615) 465-7000 | Poplar Bluff Regional Medical Center, Llc 130 E Harbin Ave Puxico MO 63960-9104 Ph: (573) 222-3556 |
| NPI Number | 1750797775 |
|---|---|
| Provider Enumeration Date | 07/10/2014 |
| Last Update Date | 07/29/2014 |
| Medicare PECOS PAC ID | 6800707225 |
|---|---|
| Medicare Enrollment ID | O20071116000008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750797775 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Angela Patterson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144245523 PECOS PAC ID: 2567419450 Enrollment ID: I20061023000437 |
| Provider Name | Bijan Bastaninejad |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1972589968 PECOS PAC ID: 2961423264 Enrollment ID: I20100519000419 |
| Provider Name | Kimberly Dawn Te |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497036297 PECOS PAC ID: 9931323235 Enrollment ID: I20140606000342 |
| Provider Name | Holly Reed |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235487885 PECOS PAC ID: 2961550900 Enrollment ID: I20141202000689 |
| Provider Name | Jane Grace Outlaw Anni |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1457741332 PECOS PAC ID: 9234457235 Enrollment ID: I20150422001402 |
Poplar Bluff Regional Medical Center Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 130 E Harbin Ave, Puxico, MO 63960 Phone: 573-222-3556 | |
Woods Medical Clinic, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 250 S Hickman St, Puxico, MO 63960 Phone: 573-222-2292 Fax: 573-222-2383 |