EBO MD OF POPLAR BLUFF LLC NPI 1770152035

NPI Information

  • NPI: 1770152035
  • Provider Name: EBO MD OF POPLAR BLUFF LLC
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • CLIA Number: 26D2229143
  • Address: 2725 N WESTWOOD BLVD
    POPLAR BLUFF, MO
    ZIP 63901
  • Phone: (573) 686-5510

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NPI Details

EBO MD OF POPLAR BLUFF LLC is a family medicine in Poplar Bluff, MO. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. EBO MD OF POPLAR BLUFF LLC NPI is 1770152035. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2725 N WESTWOOD BLVD
POPLAR BLUFF, MO
ZIP 63901-346
Phone: (573) 686-5510

The provider's authorized official is Philip James Crocker .
The authorized official title is Cfo and has the following contact phone number (573) 686-5510.

The CLIA number assigned to this NPI record is 26D2229143 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/22/2021 and was last updated on 7/26/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineYes

What is NPI?

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This page was last updated on: 3/30/2025

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