Poplar Bluff Medical Partners, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

NOT REQUIRED Issued in MO

Legal business name

POPLAR BLUFF MEDICAL PARTNERS, LLC

Practice address

221 Physicians Park
Poplar Bluff, MO 63901-3956

Phone

(573) 727-9080

Fax

(573) 686-1245

NPI assigned

Oct 20, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Michael Burcham, MBA

Title

President, Ceo

Phone

(573) 727-9080

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1407845472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9080",
            "fax_number": "573-686-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9080",
            "fax_number": "573-686-1245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF MEDICAL PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-20",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "BURCHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "573-727-9080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Magnetic Resonance Imaging (MRI)",
            "state": "MO",
            "license": "NOT REQUIRED",
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "MO",
            "license": "NOT REQUIRED",
            "primary": true
        },
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "MO",
            "license": "NOT REQUIRED",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "710426909",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.