POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC – NPI #1104963354
Radiology

POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC is a radiologist located in POPLAR BLUFF, MO. NPPES has assigned the NPI number 1104963354 to POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC on January 30, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 2085R0203X from the Health Care Provider Taxonomy code set, which is classified as Radiology, specializing in Radiation Oncology

The NPI profile was previously updated about 16 years ago on May 24, 2010. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC below.

NPI Profile for
POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC

NPI Number
1104963354
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC
Primary location
2620 N WESTWOOD BLVD
POPLAR BLUFF, MO 63901-3396
Phone: (573) 686-5300 Fax:
Mailing address
PO BOX 958262
SAINT LOUIS, MO 63195-8262
Phone: (636) 207-0537 Fax: (636) 207-0221
Organization Subpart
No
Authorized Official
SUBHASH GUJARATI
PHYSICIAN
Phone: (573) 686-5300
Updated
Identifiers

Identifiers for POPLAR BLUFF CANCER & RADIATION SPECIALIST LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
MEDICAIDMO711887000
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
2085R0203X
- Radiology / Radiation Oncology (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.