Essential Family Healthcare, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R9B65 Issued in MO

Legal business name

ESSENTIAL FAMILY HEALTHCARE, LLC

Practice address

1369 North Westwood Blvd.
Poplar Bluff, MO 63901

Phone

(573) 714-6337

NPI assigned

Jan 15, 2014

Last updated

Jan 15, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelly Gresham, RN, APN

Title

RN, Apn, Member

Phone

(573) 714-6337

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1389744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389744000000",
    "number": "1932521648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1369 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013313",
            "telephone_number": "573-714-6337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1369 NORTH WESTWOOD BLVD.",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901",
            "telephone_number": "573-714-6337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESSENTIAL FAMILY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-15",
        "last_updated": "2014-01-15",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "RN, APN, MEMBER",
        "authorized_official_telephone_number": "573-714-6337",
        "authorized_official_credential": "RN, APN"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MO",
            "license": "126637",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MO",
            "license": "R9B65",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; 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.