NPIMap

Organization Active NPI

Black River Healthcare, Inc.

  • Rural Health Clinic/Center
  • Poplar Bluff, MO
National Provider Identifier
1376841064
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BLACK RIVER HEALTHCARE, INC.
Practice address
1879 N Westwood Blvd
Poplar Bluff, MO 63901-2833
Phone
(573) 727-9793
Fax
(573) 785-1854
NPI assigned
Mar 4, 2011
Last updated
Jul 19, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

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

Authorized official

Name
Mrs. Shelly Yvonne Gresham, FNP
Title
Family Nurse Practitioner
Phone
(573) 727-9793

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO Primary

Addresses

Primary practice location

1879 N Westwood Blvd
Poplar Bluff, MO 63901-2833

Mailing address

1879 N Westwood Blvd
Poplar Bluff, MO 63901-2833
Phone (573) 727-9793

National Provider Directory

National Provider Directory

Locations

1879 N Westwood Blvd
Poplar Bluff, MO 63901
Phone (573) 727-9793

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1299196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1376841064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012833",
            "telephone_number": "573-727-9793",
            "fax_number": "573-785-1854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012833",
            "telephone_number": "573-727-9793",
            "fax_number": "573-785-1854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-04",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "GRESHAM",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "573-727-9793",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; 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.