Organization
BLACK RIVER MEDICAL GROUP, LLC
Active
Parent organization
BLACK RIVER COMMUNITY MEDICAL CENTER
Other names
Black River Medical Partners
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK RIVER COMMUNITY MEDICAL CENTER
Authorized official
MR. MICHAEL G BURCHAM SR. MBA, RRT (PRESIDENT & CEO)
(573) 727-9125
Entity
Organization
Contact information
Practice address
225 PHYSICIANS PARK, SUITE 204, POPLAR BLUFF, MO 63901-3956
(573) 785-4601
Mailing address
217 PHYSICIANS PARK DRIVE, POPLAR BLUFF, MO 63901-3956
(573) 727-9125
(573) 686-1245
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
10/29/2012
Last updated
11/26/2012
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