Black River Medical Center

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

BLACK RIVER MEDICAL CENTER

Practice address

217 Physicians Park
Poplar Bluff, MO 63901-3956

Phone

(573) 727-9080

NPI assigned

Jan 9, 2014

Organization subpart

No

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

Authorized official

Name

Christy L Shawan

Title

Ceo

Phone

(866) 916-5259

Specialties & licenses 2

Addresses

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.

• DO Not Use

  • Rural Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1477891406
  NPD tax ID

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1992127088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-727-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "SHAWAN",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "866-916-5259"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• Emergency Medicine Physician in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Emergency Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; 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.