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SOUTHEAST MISSOURI RESIDENTIAL SERVICES-POPLAR BLUFF PROF GRP
NPI 1740560580
Family Medicine in Poplar Bluff, MO

Active since August 25, 2011
2351 KANELL BLVD, POPLAR BLUFF, MO 63901(573) 840-9370(573) 840-9373 Get Directions Write a Review

NPPES record last updated: October 15, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Oct 15, 2020, Aug 26, 2019 (2 updates tracked since 2019).

About Southeast Missouri Residential Services-poplar Bluff Prof Grp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOUTHEAST MISSOURI RESIDENTIAL SERVICES-POPLAR BLUFF PROF GRP (NPI 1740560580) is a healthcare organization registered as a family medicine in Poplar Bluff, Missouri and active in the NPI registry since August 2011. The organization lists Molly Jane Boeckmann, Director Of Administrative Services, as its authorized official.

NPPES Registry Identity

NPI1740560580
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameSTATE OF MISSOURI
Location Address2351 KANELL BLVDPoplar Bluff, MO 63901-4035
Mailing AddressPo Box 687Jefferson City, MO 65102-0687 · (573) 751-3398 · Fax (573) 526-4560
Phone(573) 840-9370
Fax(573) 840-9373
Organization SubpartYes
Authorized OfficialMolly Jane BoeckmannDirector Of Administrative Services · (573) 751-4055
Enumeration DateAugust 25, 2011
Last NPPES UpdateOctober 15, 20202 updates tracked since enumeration
NPPES CertifiedOctober 15, 2020
✔ NPI 1740560580 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
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.
Also ListedEmergency MedicineTaxonomy 207P00000X
2351 KANELL BLVD, Poplar Bluff, MO 63901
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Other Names 1

Doing Business AsSoutheast Missouri Residential Services-poplar Bluff Prof Grp

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

STATE OF MISSOURI
Case Management
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Intermediate Care Facility, Intellectual Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9370
STATE OF MISSOURI
Day Training, Developmentally Disabled Services
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
SOUTHEAST MISSOURI RESIDENTIAL SERVICES
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9300
STATE OF MISSOURI
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
2351 KANELL BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 840-9374

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is State Of Missouri's NPI number?

The NPI number for State Of Missouri is 1740560580. It was assigned to this organization in the NPPES registry on August 25, 2011. The provider is doing business as Southeast Missouri Residential Services-Poplar Bluff Prof Grp.

Where is State Of Missouri located?

State Of Missouri is located at 2351 Kanell Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 840-9370.

What is State Of Missouri's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

When was this NPI record last updated?

The NPPES record for State Of Missouri was last updated on October 15, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.