MID-SOUTH HEALTH CLINIC LLC (NPI# 1073595096) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073595096 |
| Entity Type | Organization |
| Organization Name | MID-SOUTH HEALTH CLINIC LLC |
| Practice Address |
3100 Warrior Ln Poplar Bluff MO 63901-8686 |
| Mailing Address |
233 E Center Dr Alton IL 62002-5931 |
| Practice Telephone | 5737850851 |
| Mailing Telephone | 6184657717 |
| Mailing Fax Number | 6184657710 |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2008-07-10 |
| Authorized Official Name | JOETTA MARTIN (ADMINISTRATOR) |
| Authorized Official Telephone | 5737850851 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
031640 | MO | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 598977007 | 05 |
| Street Address |
3100 WARRIOR LN |
| City | POPLAR BLUFF |
| State | MO |
| Zip Code | 63901-8686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609864081 | Helia Healthcare of Poplar Bluff, LLC | Durable Medical Equipment & Medical Supplies | 3100 Warrior Ln, Poplar Bluff, MO 63901-8686 | 2005-10-11 |
| 1972915486 | Julianna Kuper | Social Worker | 3100 Warrior Ln, Poplar Bluff, MO 63901-8686 | 2014-06-02 |
| 1710302989 | Jeri Mcconnell | Case Manager/Care Coordinator | 3100 Warrior Ln, Poplar Bluff, MO 63901-8686 | 2014-02-25 |
| 1699003210 | Damon Davis | Clinical Nurse Specialist | 3100 Warrior Ln, Poplar Bluff, MO 63901-8686 | 2009-11-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568076701 | Alternative Sleep Solution | Dentist | 2700 Kanell Blvd., Poplar Bluff, MO 63901 | 2020-09-04 |
| 1285271239 | Front Door Wellness LLC | Physical Therapist | Front Door Wellness LLC, 5835 Quail Meadows Drive, Poplar Bluff, MO 63901 | 2019-12-09 |
| 1104470368 | Andrew Akindutire | Dentist | 3101 Oak Groove Rd., Suite 6, Poplar Bluff, MO 63901 | 2019-07-26 |
| 1780195966 | Midwest Equipment Srv Systems LLC | Technician, Pathology | 2400 Lucy Lee Parkway, Suite C, Poplar Bluff, MO 63901 | 2017-10-16 |
| 1801259387 | Richard Justin Huber | Technician, Other | 3005 Warrior Ln, Poplar Bluff, MO 63901 | 2016-04-01 |
| 1699136275 | Donja Kirkland | Recreation Therapist | 1910a Greenwood Dr., Suite D, Poplar Bluff, MO 63901 | 2016-03-10 |
| 1760866867 | Bio-medical Applications of Missouri, Inc. | Clinic/Center | 3050 Tucker Road, Poplar Bluff, MO 63901 | 2015-07-17 |
| 1407246390 | Lisa Marie Payne | Physical Therapist | 4358c Highway Pp, Poplar Bluff, MO 63901 | 2015-01-29 |
| 1700202488 | Missouri Dental Professionals, Richard Straus, Dmd, PC | Dentist | 1602 W. Harper Street, Poplar Bluff, MO 63901 | 2014-03-05 |
| 1932521648 | Essential Family Healthcare, LLC | Clinic/Center | 1369 North Westwood Blvd., Poplar Bluff, MO 63901 | 2014-01-15 |
| Find all providers in zip 63901 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275511859 | Kneibert Clinic LLC | Clinic/Center | 2588 N Westwood Blvd, Poplar Bluff, MO 63901 | 2006-01-04 |
| 1356849616 | Heartland Women's Healthcare Mo PC | Clinic/Center | 2340 Katy Ln, Poplar Bluff, MO 63901-2300 | 2018-01-31 |
| 1457881963 | Poplar Bluff Pediatric Assoc Ll | Clinic/Center | 2210 Barron Rd, Poplar Bluff, MO 63901-1908 | 2017-06-16 |
| 1508237926 | Family Counseling Center, Inc. | Clinic/Center | 3001 Warrior Ln, Poplar Bluff, MO 63901-8685 | 2015-10-12 |
| 1780927871 | Southeast Health Center of Stoddard County, LLC | Clinic/Center | 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 | 2013-03-27 |
| 1225380108 | Poplar Bluff Regional Medical Center, LLC | Clinic/Center | 2360 Katy Ln, Poplar Bluff, MO 63901-2300 | 2012-10-03 |
| 1881965267 | Poplar Bluff Regional Medical Center, LLC | Clinic/Center | 2588 N Westwood Blvd, Poplar Bluff, MO 63901-2535 | 2012-01-18 |
| 1376841064 | Black River Healthcare, Inc. | Clinic/Center | 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833 | 2011-03-04 |
| 1144451063 | Internal Medicine Associates of Southeast Missouri LLC | Clinic/Center | 225 Physicians Park, Poplar Bluff, MO 63901-3956 | 2009-07-28 |
| 1629208848 | Internal Medicine Associates of Southeast Missouri LLC | Clinic/Center | 223 Physicians Park, Poplar Bluff, MO 63901-3956 | 2009-07-22 |
| Find all providers in POPLAR BLUFF | ||||
| City | POPLAR BLUFF |
| Zip Code | 63901 |
Please comment or provide details below to improve the information on MID-SOUTH HEALTH CLINIC LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.