Organization
BLACK RIVER MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTY L SHAWAN (CEO)
(866) 916-5259
Entity
Organization
Contact information
Practice address
217 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 727-9080
Mailing address
217 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 727-9080
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
01/09/2014
Last updated
01/17/2014
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