Organization
BLACK RIVER AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID C PRATHER CPA, MBA (CHIEF FINANCIAL OFFICER)
(573) 331-5129
Entity
Organization
Contact information
Practice address
219 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 609-2444
Mailing address
219 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
05/20/2019
Last updated
05/20/2019
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