Internal Medicine Associates of Southeast Missouri LLC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

INTERNAL MEDICINE ASSOCIATES OF SOUTHEAST MISSOURI LLC

Doing business as

Physicians Park Primary Care

Practice address

225 Physicians Park
Poplar Bluff, MO 63901-3956

Phone

(573) 727-5500

Fax

(573) 686-1315

NPI assigned

Jul 28, 2009

Organization subpart

No

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

Authorized official

Name

Mrs. Carolyn Crites

Title

Administrator

Phone

(573) 727-5500

Specialties & licenses 1

Addresses

Other names 1

• Physicians Park Primary Care Doing business as

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1144451063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-5500",
            "fax_number": "573-686-1315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-5500",
            "fax_number": "573-686-1315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE ASSOCIATES OF SOUTHEAST MISSOURI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "CRITES",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "573-727-5500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Park Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Associates of Southeast Missouri LLC (Physicians Park Primary Care)
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• Susan Ann Isenman
• Yetunde Ishola

• Rural Health Clinic/Center in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Rural Health Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; 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.