Organization · Type 2 NPI

Black River Health Services Inc

Federally Qualified Health Center (FQHC) · Burgaw, NC

NPI number 1093703886 Active

Practice location

301 S Campbell St
Burgaw, NC 28425-5011

Fax (910) 259-8002

Specialties and licenses

Taxonomy	Code	License
Family Medicine Physician	207Q00000X	None listed
Internal Medicine Physician	207R00000X	None listed
Federally Qualified Health Center (FQHC) Primary	261QF0400X	None listed
Rural Health Clinic/Center	261QR1300X	None listed

Federally Qualified Health Center (FQHC): Definition to come...

8 other providers at this address

NPI record

NPI: 1093703886
Entity type: Organization (Type 2)
Issued: Oct 6, 2005
Last updated: Dec 12, 2019
Status: Active

Other names

<unavail>
Black River Family Practice · doing business as
Black River Family Practice · doing business as

Authorized official

Lee Ann Amann
Administrator
(910) 259-6973

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1093703886

Black River Health Services Inc's National Provider Identifier is 1093703886, issued on Oct 6, 2005. The primary taxonomy on file is Federally Qualified Health Center (FQHC) (261QF0400X), and the practice location is in Burgaw, NC. The record was last updated on Dec 12, 2019.