Provider Demographics
NPI:1447256987
Name:PLUNKETT FAMILY CARE CENTER LLC
Entity type:Organization
Organization Name:PLUNKETT FAMILY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LITTLETON
Authorized Official - Middle Name:J
Authorized Official - Last Name:PLUNKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-686-5564
Mailing Address - Street 1:2480 THREE RIVERS BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2318
Mailing Address - Country:US
Mailing Address - Phone:573-686-5564
Mailing Address - Fax:573-686-2838
Practice Address - Street 1:2480 THREE RIVERS BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2318
Practice Address - Country:US
Practice Address - Phone:573-686-5564
Practice Address - Fax:573-686-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3284207Q00000X
MO268906261QR1300X
MO089729363LF0000X
MO143295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO268906Medicare ID - Type UnspecifiedRHC MEDICARE PROVIDER ID