Organization
BLACK RIVER HEALTHCARE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHELLY YVONNE GRESHAM FNP (FAMILY NURSE PRACTITIONER)
(573) 727-9793
Entity
Organization
Contact information
Practice address
1879 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2833
(573) 727-9793
(573) 785-1854
Mailing address
1879 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2833
(573) 727-9793
(573) 785-1854
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
MO
Other
Enumeration date
03/04/2011
Last updated
07/19/2011
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