BLACK RIVER HEALTHCARE, INC.


Address: 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833
Phone: 5737279793

BLACK RIVER HEALTHCARE, INC. (NPI# 1376841064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1376841064
Entity Type Organization
Organization Name BLACK RIVER HEALTHCARE, INC.
Practice Address 1879 N Westwood Blvd
Poplar Bluff
MO 63901-2833
Practice Telephone 5737279793
Practice Fax Number 5737851854
Mailing Telephone 5737279793
Mailing Fax Number 5737851854
Enumeration Date 2011-03-04
Last Update Date 2011-07-19
Authorized Official Name MRS. SHELLY YVONNE GRESHAM (FAMILY NURSE PRACTITIONER)
Authorized Official Telephone 5737279793
Authorized Official Credential FNP
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QR1300X Clinic/Center
Specialization: Rural Health
MO Ambulatory Health Care Facilities

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1992077424 Black River Healthcare, Inc. Nurse Practitioner 11 W. Hospital St., Manning, SC 29102-2925 2012-01-30
1699969733 Black River Healthcare, Inc. Obstetrics & Gynecology 500 Thurgood Marshall Boulevard, Suite A, Kingstree, SC 29556 2007-08-31
1275566440 Black River Healthcare, Inc. Registered Nurse 206 East Market Street, Timmonsville, SC 29161 2006-07-09
1508809542 Black River Healthcare, Inc. Clinic/Center 139 Main Street, Olanta, SC 29114 2006-06-14
1497798599 Black River Healthcare, Inc. Clinic/Center 520 Thurgood Marshall Blvd., Suite B, Kingstree, SC 29556 2006-06-14
1871531574 Black River Healthcare, Inc. Pediatrics 12 W South St, Manning, SC 29102-2925 2006-06-03
1558308965 Black River Healthcare, Inc. Nurse Practitioner 86 N Main St, Greeleyville, SC 29056-9374 2006-06-02

Office Location

Street Address 1879 N WESTWOOD BLVD
City POPLAR BLUFF
State MO
Zip Code 63901-2833

Providers in the same location

NPI Name Taxonomy Address Enumeration
1700882016 Stephen A Segall Internal Medicine 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833 2005-06-22
1831612209 Megan Leigh Montgomery-nibbe Chiropractor 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833 2017-07-18
1912310640 Shaun David Nibbe Chiropractor 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833 2014-06-10

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Taxonomy Information

Taxonomy Code 261QR1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Rural Health

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1275511859 Kneibert Clinic LLC Clinic/Center 2588 N Westwood Blvd, Poplar Bluff, MO 63901 2006-01-04
1356849616 Heartland Women's Healthcare Mo PC Clinic/Center 2340 Katy Ln, Poplar Bluff, MO 63901-2300 2018-01-31
1457881963 Poplar Bluff Pediatric Assoc Ll Clinic/Center 2210 Barron Rd, Poplar Bluff, MO 63901-1908 2017-06-16
1508237926 Family Counseling Center, Inc. Clinic/Center 3001 Warrior Ln, Poplar Bluff, MO 63901-8685 2015-10-12
1780927871 Southeast Health Center of Stoddard County, LLC Clinic/Center 2002 Kanell Blvd, Poplar Bluff, MO 63901-4045 2013-03-27
1225380108 Poplar Bluff Regional Medical Center, LLC Clinic/Center 2360 Katy Ln, Poplar Bluff, MO 63901-2300 2012-10-03
1881965267 Poplar Bluff Regional Medical Center, LLC Clinic/Center 2588 N Westwood Blvd, Poplar Bluff, MO 63901-2535 2012-01-18
1144451063 Internal Medicine Associates of Southeast Missouri LLC Clinic/Center 225 Physicians Park, Poplar Bluff, MO 63901-3956 2009-07-28
1629208848 Internal Medicine Associates of Southeast Missouri LLC Clinic/Center 223 Physicians Park, Poplar Bluff, MO 63901-3956 2009-07-22
1578517918 Christopher R. Montgomery, Md Clinic/Center 2400 Lucy Lee Pkwy, Suite B, Poplar Bluff, MO 63901-2429 2006-05-20
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Competitor

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City POPLAR BLUFF
Zip Code 63901

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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