Organization
BLACK RIVER HEALTH SERVICES INC
Active
Organization
BLACK RIVER HEALTH SERVICES INC
Active
Other names
Black River Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ANN AMANN (ADMINISTRATOR)
(910) 259-6973
Entity
Organization
Contact information
Practice address
301 S CAMPBELL ST, BURGAW, NC 28425-5011
(910) 259-5721
(910) 259-8002
Mailing address
301 S CAMPBELL ST, BURGAW, NC 28425-5011
(910) 259-6973
(910) 259-6975
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0104X
BCBS
—
05
—
343905AC
—
NC
Enumeration date
10/06/2005
Last updated
12/12/2019
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