NPIMap

Organization Active NPI

Kneibert Clinic LLC

  • Health Service Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1821240896
Registry record updated Oct 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
KNEIBERT CLINIC LLC
Practice address
686 Lester St
Poplar Bluff, MO 63901-5025
Phone
(573) 686-2411
NPI assigned
Oct 21, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2008

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

Authorized official

Name
Tom R Warner
Title
Asst Administrator
Phone
(573) 778-7175

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary

Addresses

Primary practice location

686 Lester St
Poplar Bluff, MO 63901-5025

Mailing address

686 Lester St
Poplar Bluff, MO 63901-5025
Phone (573) 686-2411

Other identifiers 1

IdentifierTypeStateIssuer
161274722MedicaidAR

National Provider Directory

National Provider Directory
Tax ID family
Kneibert Clinic LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

686 Lester St
Poplar Bluff, MO 63901
Phone (573) 686-2411

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224547200000",
    "number": "1821240896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "686 LESTER ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015025",
            "telephone_number": "573-686-2411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "686 LESTER ST",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639015025",
            "telephone_number": "573-686-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNEIBERT CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2008-10-21",
        "status": "A",
        "authorized_official_last_name": "WARNER",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ASST  ADMINISTRATOR",
        "authorized_official_telephone_number": "573-778-7175"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161274722",
            "state": "AR"
        }
    ],
    "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 21, 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.