| Black River Ambulatory Surgery Center, Llc | |
|
219 Physicians Park Poplar Bluff MO 63901-3956 | |
| (573) 609-2444 | |
| Not Available |
| Full Name | Black River Ambulatory Surgery Center, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 219 Physicians Park, Poplar Bluff, Missouri |
| Authorized Official Name and Position | David C Prather (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5733315129 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black River Ambulatory Surgery Center, Llc 219 Physicians Park Poplar Bluff MO 63901-3956 Ph: () - | Black River Ambulatory Surgery Center, Llc 219 Physicians Park Poplar Bluff MO 63901-3956 Ph: (573) 609-2444 |
| NPI Number | 1770149304 |
|---|---|
| Provider Enumeration Date | 05/20/2019 |
| Last Update Date | 05/20/2019 |
| Medicare PECOS PAC ID | 1456687003 |
|---|---|
| Medicare Enrollment ID | O20190719002275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770149304 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Primary |
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