Black River Medical Group, LLC
NPI #1386998318 in Poplar Bluff, Missouri
Provider Information
- NPI Number
- 1386998318
- Entity Type
- Organization
- Organization Name
- Black River Medical Group, LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- BLACK RIVER COMMUNITY MEDICAL CENTER
- Primary Specialty
- Surgery
- Enumeration Date
- Oct 29, 2012
- Last Updated
- Nov 26, 2012
Practice Location
- Address
- 225 PHYSICIANS PARK
- Address 2
- SUITE 204
- City
- Poplar Bluff
- State
- Missouri
- ZIP Code
- 63901-3956
- Phone
- (573) 785-4601
Authorized Official
- Name
- MR. MICHAEL G BURCHAM SR., MBA, RRT
- Title
- PRESIDENT & CEO
- Phone
- (573) 727-9125
Specialties & Taxonomy Codes
| Specialty |
|---|
| Surgery |
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