BLACK RIVER HEALTHCARE, INC. (NPI# 1508809542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508809542 |
| Entity Type | Organization |
| Organization Name | BLACK RIVER HEALTHCARE, INC. |
| Other Organization Name | BRH - OLANTA |
| Practice Address |
139 Main Street Olanta SC 29114 |
| Mailing Address |
Po Box 578 Manning SC 29102-0578 |
| Practice Telephone | 8034331216 |
| Practice Fax Number | 8034336796 |
| Mailing Telephone | 8034331216 |
| Mailing Fax Number | 8034336796 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2008-04-08 |
| Authorized Official Name | MS. BARBARA BROOKS (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 8034331216 |
| Is Organization Subpart | Y |
| Parent Organization Name | BLACK RIVER HEALTHCARE, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QR1300X |
Clinic/Center Specialization: Rural Health |
27146 | SC | Ambulatory Health Care Facilities |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | MEDICARE PART B | 4400 | 01 |
| Other Name | Type Code |
|---|---|
| BRH - Olanta | Other Name - Individual/Organization |
| 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 |
| 1497798599 | Black River Healthcare, Inc. | Clinic/Center | 520 Thurgood Marshall Blvd., Suite B, Kingstree, SC 29556 | 2006-06-14 |
| 1376841064 | Black River Healthcare, Inc. | Clinic/Center | 1879 N Westwood Blvd, Poplar Bluff, MO 63901-2833 | 2011-03-04 |
| 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 |
| Street Address |
139 MAIN STREET |
| City | OLANTA |
| State | SC |
| Zip Code | 29114 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619995065 | Rebecca Ruth Haskill Strowd | Family Medicine | 139 Main Street, Olanta, SC 29114-0488 | 2006-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518064229 | Pee Dee Healthcare Pa | Clinic/Center | 211 South Jones Road, Olanta, SC 29114 | 2006-09-17 |
| 1841272895 | Priscilla L Welch | Family Medicine | 211 South Jones Rd, Olanta, SC 29114 | 2005-11-16 |
| 1003043845 | Pee Dee Health Care, Pa | Clinic/Center | 211 South Jones Rd, Olanta, SC 29114 | 2009-06-19 |
| 1265535520 | Monica Michelle Vargas | Pharmacist | 223 N Jones Rd, Olanta, SC 29114 | 2006-09-05 |
| 1528172384 | Mary G. Daniels | Nurse Practitioner | 139 Main St, Olanta, SC 29114 | 2006-08-18 |
| 1306953096 | F & L Drug Store Inc | Pharmacy | 223 N Jones Rd, Olanta, SC 29114-0428 | 2006-08-25 |
| 1003253519 | Barbara Brown | Registered Nurse | 312 N. Jones Road, Olanta, SC 29114-0628 | 2013-05-24 |
| 1649623653 | Woods Bay Family Care LLC | Clinic/Center | 128 E Baker St, Olanta, SC 29114-9101 | 2016-07-14 |
| 1063859338 | Dixie M Floyd | Licensed Practical Nurse | 4006 Rhett Dr, Olanta, SC 29114-9366 | 2013-05-28 |
| 1457500142 | Priscilla L. Welch | Durable Medical Equipment & Medical Supplies | 211 S. Jones Street, Suite B, Olanta, SC 29114-9493 | 2008-09-17 |
| Find all providers in zip 29114 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841272895 | Priscilla L Welch | Family Medicine | 211 South Jones Rd, Olanta, SC 29114 | 2005-11-16 |
| 1619995065 | Rebecca Ruth Haskill Strowd | Family Medicine | 139 Main Street, Olanta, SC 29114-0488 | 2006-07-17 |
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| Find all providers with the same taxonomy | ||||
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| 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.