| Black River Family Practice | |
|
301 S Campbell St Burgaw NC 28425-5011 | |
| (910) 259-5721 | |
| (910) 259-8002 |
| Full Name | Black River Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 301 S Campbell St, Burgaw, North Carolina |
| Authorized Official Name and Position | Lee Ann Amann (ADMINISTRATOR) |
| Authorized Official Contact | 9102596973 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Black River Family Practice 301 S Campbell St Burgaw NC 28425-5011 Ph: (910) 259-6973 | Black River Family Practice 301 S Campbell St Burgaw NC 28425-5011 Ph: (910) 259-5721 |
| NPI Number | 1093703886 |
|---|---|
| Provider Enumeration Date | 10/06/2005 |
| Last Update Date | 12/12/2019 |
| Medicare PECOS PAC ID | 0345131579 |
|---|---|
| Medicare Enrollment ID | O20180504001078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093703886 | NPI | - | NPPES |
| 0104X | Other | BCBS | |
| 343905AC | Medicaid | NC |
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