| Organization Name: | THE SURGERY CENTER OF POPLAR BLUFF |
| NPI Number: | 1053300012 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRISTY L SHAWAN (COO LEAD ADMIN.) |
| Mailing Address: | 219 Physicians Park Drive Poplar Bluff |
| State: | MO US |
| Postal Code: | 639013956 |
| Phone Number: | 5737279080 |
| Fax Number: | 5737122106 |
| NPI Enumeration Date: | 10/20/2005 |
| NPI Last Update Date: | 05/03/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 124-3 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |