NPIMap

Organization Active NPI

Poplar Bluff Radiology Services Inc

  • Diagnostic Radiology Physician
  • Poplar Bluff, MO
National Provider Identifier
1073793642
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R4N69 Issued in MO
Legal business name
POPLAR BLUFF RADIOLOGY SERVICES INC
Practice address
1720 Kanell Blvd
Suite1
Poplar Bluff, MO 63901-4009
Phone
(573) 778-1336
Fax
(573) 778-1336
NPI assigned
Nov 12, 2007
Last updated
Oct 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Kimberly McVey
Title
Secretary/Treasurer
Phone
(573) 718-0181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R4N69 MO Primary

Addresses

Primary practice location

1720 Kanell Blvd
Suite1
Poplar Bluff, MO 63901-4009

Mailing address

PO Box 1618
Poplar Bluff, MO 63902-1618
Phone (573) 778-1336

National Provider Directory

National Provider Directory

Locations

1720 Kanell Blvd
Ste 1
Poplar Bluff, MO 63901
Phone (573) 778-1336

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381881600000",
    "number": "1073793642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1618",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639021618",
            "telephone_number": "573-778-1336",
            "fax_number": "573-778-1336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 KANELL BLVD",
            "address_2": "SUITE1",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639014009",
            "telephone_number": "573-778-1336",
            "fax_number": "573-778-1336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF RADIOLOGY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2013-10-16",
        "status": "A",
        "authorized_official_last_name": "MCVEY",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "SECRETARY/TREASURER",
        "authorized_official_telephone_number": "573-718-0181",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R4N69",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.