Black River Health Services, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BLACK RIVER HEALTH SERVICES, INC.

Doing business as

Black River Family Practice at Rocky Point

Practice address

7910 US Highway 117 S
Suite 120
Rocky Point, NC 28457-7409

Phone

(910) 675-0120

Fax

(910) 675-2308

NPI assigned

Sep 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Scott Martin

Title

Executive Director

Phone

(910) 259-6973

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Black River Family Practice at Rocky Point Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1188950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1013101781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 S CAMPBELL ST",
            "city": "BURGAW",
            "state": "NC",
            "postal_code": "284255011",
            "telephone_number": "910-259-6973",
            "fax_number": "910-259-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 US HIGHWAY 117 S",
            "address_2": "SUITE 120",
            "city": "ROCKY POINT",
            "state": "NC",
            "postal_code": "284577409",
            "telephone_number": "910-675-0120",
            "fax_number": "910-675-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTH SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "910-259-6973"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5908417",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS NC",
            "identifier": "020A0",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black River Family Practice at Rocky Point",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Autism Support and Programs
• Mariela Avila, LCSWA, LCASA
• Talisa Bannerman-Lee, P.T., DPT
• Kevin D Baskin
• Catharine Batson
• Tracy Black, S.L.P.
• Shanna Pollock Bradshaw, PA
• Carol Burkie
• Michael B Bush, DDS
• Sarah Abbitt Bush, MS, RD

• Specialist in Rocky Point, NC
• Providers in Rocky Point, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.