Black River Ambulatory Surgery Center, LLC
NPI #1770149304 in Poplar Bluff, Missouri
Provider Information
- NPI Number
- 1770149304
- Entity Type
- Organization
- Organization Name
- Black River Ambulatory Surgery Center, LLC
- Primary Specialty
- Clinic/Center - Ambulatory Surgical
- Enumeration Date
- May 20, 2019
- Last Updated
- May 20, 2019
Practice Location
- Address
- 219 PHYSICIANS PARK
- City
- Poplar Bluff
- State
- Missouri
- ZIP Code
- 63901-3956
- Phone
- (573) 609-2444
Authorized Official
- Name
- MR. DAVID C PRATHER, CPA, MBA
- Title
- CHIEF FINANCIAL OFFICER
- Phone
- (573) 331-5129
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Multi-Specialty — Multi-Specialty |
| Clinic/Center - Ambulatory Surgical — Ambulatory Surgical |
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