Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

State of Missouri

Organization Emergency Medicine Physician · NPI 1740560580

State of Missouri is an Emergency Medicine Physician in Poplar Bluff, Missouri. Registered with an NPI since 2011.

In the registry since
2011
Specialties on file
2
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Practice location Address checks out

2351 Kanell Blvd
Poplar Bluff, MO 63901-4035
Phone: (573) 840-9370
Fax: (573) 840-9373
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X
Emergency Medicine Physician Taxonomy 207P00000X

Record details

NPI number1740560580
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationState of Missouri
Authorized official Molly Boeckmann — Director Of Administrative Services · (573) 751-4055
Other names Southeast Missouri Residential Services-Poplar Bluff Prof Grp; Southeast Missouri Residential Services-Poplar Bluff Prof Grp
NPI enumeratedAugust 25, 2011
Last updated in NPPESOctober 15, 2020
Certification dateOctober 15, 2020
Mailing addressPo Box 687, Jefferson City, MO 65102-0687

Other providers in Poplar Bluff