| Organization Name: | MID-SOUTH HEALTH CLINIC LLC |
| NPI Number: | 1073595096 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOETTA MARTIN (ADMINISTRATOR) |
| Mailing Address: | 3100 Warrior Ln Poplar Bluff |
| State: | MO US |
| Postal Code: | 639018686 |
| Phone Number: | 5737850851 |
| Fax Number: | |
| NPI Enumeration Date: | 11/16/2005 |
| NPI Last Update Date: | 07/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 031640 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |