Black River Medical Group, LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

BLACK RIVER MEDICAL GROUP, LLC

Doing business as

Black River Medical Partners

Practice address

225 Physicians Park
Suite 204
Poplar Bluff, MO 63901-3956

Phone

(573) 785-4601

NPI assigned

Oct 29, 2012

Organization subpart

Yes

Parent organization

BLACK RIVER COMMUNITY MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Mr. Michael G Burcham Sr., MBA, RRT

Title

President & Ceo

Phone

(573) 727-9125

Specialties & licenses 1

Addresses

Other names 1

• Black River Medical Partners Doing business as

Part of

Black River Medical Center

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Black River Community Medical Center

  • Rural Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1548546138
  NPPES parent name

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

{
    "created_epoch": "1351468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353888000000",
    "number": "1386998318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 PHYSICIANS PARK DRIVE",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9125",
            "fax_number": "573-686-1245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 PHYSICIANS PARK",
            "address_2": "SUITE 204",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-785-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER MEDICAL GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK RIVER COMMUNITY MEDICAL CENTER",
        "enumeration_date": "2012-10-29",
        "last_updated": "2012-11-26",
        "status": "A",
        "authorized_official_last_name": "BURCHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "573-727-9125",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "MBA, RRT"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black River Medical Partners",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bizzee Kidz Therapy, LLC
• Black River Ambulatory Surgery Center, LLC
• Black River Community Medical Center
• Black River Healthcare, Inc.
• Black River Medical Center
• Amy Denise Blackburn, MCD, CFY-SLP
• Malarie Blackwell, PHARMD
• George F Blaich IV, D.M.D.
• George Frederick Blaich V, D.D.S.
• John R Blaich, D.M.D.

• Surgery Physician in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2012; 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.