Organization
BLACK RIVER HEALTH SERVICES INC
Active
Other names
Black River Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
LEE ANN AMANN (ADMINISTRATOR)
(910) 259-6973
Entity
Organization
Contact information
Practice address
109 W CHURCH ST, ATKINSON, NC 28421-9230
(910) 283-7783
(910) 283-7927
Mailing address
301 S CAMPBELL ST, BURGAW, NC 28425-5011
(910) 259-6973
(910) 259-6975
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03009
BCBS
—
05
—
343867AC
—
NC
Enumeration date
10/06/2005
Last updated
12/12/2019
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