| Black River Healthcare, Inc. | |
|
1879 N Westwood Blvd Poplar Bluff MO 63901-2833 | |
| (573) 727-9793 | |
| (573) 785-1854 |
| Full Name | Black River Healthcare, Inc. |
|---|---|
| Speciality | Clinic/center - Rural Health |
| Location | 1879 N Westwood Blvd, Poplar Bluff, Missouri |
| Authorized Official Name and Position | Shelly Yvonne Gresham (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 5737279793 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Black River Healthcare, Inc. 1879 N Westwood Blvd Poplar Bluff MO 63901-2833 Ph: (573) 727-9793 | Black River Healthcare, Inc. 1879 N Westwood Blvd Poplar Bluff MO 63901-2833 Ph: (573) 727-9793 |
| NPI Number | 1376841064 |
|---|---|
| Provider Enumeration Date | 03/04/2011 |
| Last Update Date | 07/19/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376841064 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (Missouri) | Primary |
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