DO Not Use

Primary specialty

Rural Acute Care HospitalTaxonomy code 282NR1301X

Legal business name

DO NOT USE

Practice address

217 Physicians Park Dr
Poplar Bluff, MO 63901-3956

Phone

(573) 727-9080

NPI assigned

Jan 25, 2013

Last updated

Feb 14, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael G Burcham Sr.

Title

Ceo

Phone

(573) 727-9080

Specialties & licenses 1

Addresses

Other names 1

• Do Not Use Other name

Tax ID family

Black River Medical Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Black River Medical Center

  • Emergency Medicine Physician
  • Poplar Bluff, MO
  • NPI 1992127088
  NPD tax ID

Locations

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

{
    "created_epoch": "1359072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1360800000000",
    "number": "1477891406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 PHYSICIANS PARK DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "63901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 PHYSICIANS PARK DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DO NOT USE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-25",
        "last_updated": "2013-02-14",
        "status": "A",
        "authorized_official_last_name": "BURCHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-727-9080",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Do Not Use",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Anthony Disalvo III, DMD
• Amy L Ditto
• Divine Family Eye Care, LLC
• Kylie Marie Divine, O.D
• Russell Louis Dixon, PSY.D.
• Kayla Brittney Dobbs, NP
• Stephane Rena Dobbs, FNP
• Misty Dawn Dodson
• Cynthia Lynn Dohogne, LCSW
• Lance Michael Dohogne, DPT

• Rural Acute Care Hospital in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Rural Acute Care Hospital in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2013; 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.