State of Missouri

NPI #1740560580 in Poplar Bluff, Missouri

Provider Information

NPI Number: 1740560580
Entity Type: Organization
Organization Name: State of Missouri
Subpart: Yes (part of a larger organization)
Parent Organization: STATE OF MISSOURI
Primary Specialty: Family Medicine
Enumeration Date: Aug 25, 2011
Last Updated: Oct 15, 2020

Practice Location

Address: 2351 KANELL BLVD
City: Poplar Bluff
State: Missouri
ZIP Code: 63901-4035
Phone: (573) 840-9370

Authorized Official

Name: MOLLY JANE BOECKMANN
Title: DIRECTOR OF ADMINISTRATIVE SERVICES
Phone: (573) 751-4055

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Emergency Medicine	207P00000X
Family Medicine	207Q00000X	Primary

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