OrganizationActive
Black River Ambulatory Surgery Center, LLC
NPI 1770149304 · Ambulatory Surgical Clinic/Center · Poplar Bluff, MO
Provider details
- NPI number
- 1770149304
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- David Prather, Chief Financial Officer(573) 331-5129
Specialties & taxonomies
Ambulatory Health Care Facilities
- Multi-Specialty Clinic/Center261QM1300X
Ambulatory Health Care Facilities
Practice location
219 Physicians Park
Poplar Bluff, MO 63901-3956
Phone: (573) 609-2444
Approximate (ZIP-level) locationGet directions
Mailing address
219 Physicians Park
Poplar Bluff, MO 63901-3956
Registry dates
- Enumerated
- 2019-05-20
- Last updated
- 2019-05-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.