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EBO MD OF POPLAR BLUFF LLC
NPI 1770152035
Family Medicine in Poplar Bluff, MO

Active since June 22, 2021CLIA 26D2229143 · Waiver
2725 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901(573) 686-5510 Get Directions Write a Review

NPPES record last updated: July 26, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 26, 2021, Jun 22, 2021 (2 updates tracked since 2021).

About Ebo Md Of Poplar Bluff Llc NPPES

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

EBO MD OF POPLAR BLUFF LLC (NPI 1770152035) is a healthcare organization registered as a family medicine in Poplar Bluff, Missouri and active in the NPI registry since June 2021. The organization holds a CLIA Waiver certificate valid through July 6, 2027 and lists Philip James Crocker, Cfo, as its authorized official.

NPPES Registry Identity

NPI1770152035
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEBO MD OF POPLAR BLUFF LLC
Location Address2725 N WESTWOOD BLVDPoplar Bluff, MO 63901-2346
Mailing Address2725 N Westwood Blvd Ste 14Poplar Bluff, MO 63901-2367 · (573) 686-5510
Phone(573) 686-5510
Organization SubpartNo
Authorized OfficialPhilip James CrockerCfo · (573) 686-5510
Enumeration DateJune 22, 2021
Last NPPES UpdateJuly 26, 20212 updates tracked since enumeration
NPPES CertifiedJuly 1, 2021
✔ NPI 1770152035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
2725 N WESTWOOD BLVD, Poplar Bluff, MO 63901
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D2229143

Ebo MD Of Poplar Bluff, LLC · Poplar Bluff, MO
Active · expires Jul 6, 2027
CLIA Number26D2229143
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2025
Certificate Expiration DateJuly 6, 2027
Laboratory DirectorTammy J. Lindsay
Laboratory Phone(573) 872-4171
Laboratory LocationEbo MD Of Poplar Bluff, LLC2725 N Westwood Blvd, Suite 14, Poplar Bluff, MO 63901
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

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

TINSLEY HOME MEDICAL SERVICES, LLC
Family Medicine
2725 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-5510
LARRY A NATIONS PT
Physical Therapist
2725 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 778-9348
OZARK BEHAVIORAL HEALTH, LLC
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
2725 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 686-5510
MR. LARRY TODD ALLEN L.P.C.
Counselor (Professional)
2725 N WESTWOOD BLVD, SUITE 5A
POPLAR BLUFF, MO 63901
Butler County (573) 785-0333
QUALITY CHOICE HEARING AID CENTER,INC
Clinic/Center (Hearing and Speech)
2725 N WESTWOOD BLVD, SUITE #3
POPLAR BLUFF, MO 63901
Butler County (573) 686-6500
JOYCE LONG
Hearing Instrument Specialist
2725 N WESTWOOD BLVD, SUITE #3
POPLAR BLUFF, MO 63901
Butler County (573) 686-6500
ZULEIKA DANIELLE MATLOCK PTA
Physical Therapy Assistant
2725 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 778-9348
CHARLES WAYNE ROBERTSON PTA
Physical Therapy Assistant
2725 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901
Butler County (573) 778-9348

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 Ebo MD Of Poplar Bluff LLC's NPI number?

The NPI number for Ebo MD Of Poplar Bluff LLC is 1770152035. It was assigned to this organization in the NPPES registry on June 22, 2021.

Where is Ebo MD Of Poplar Bluff LLC located?

Ebo MD Of Poplar Bluff LLC is located at 2725 N Westwood Blvd, Poplar Bluff, MO 63901. The listed phone number is (573) 686-5510.

What is Ebo MD Of Poplar Bluff LLC's specialty?

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

Does Ebo MD Of Poplar Bluff LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D2229143) is associated with this NPI, valid through July 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Ebo MD Of Poplar Bluff LLC was last updated on July 26, 2021. 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.