BLACK RIVER FAMILY PRACTICE
NPI 1093703886
Clinic/Center - Federally Qualified Health Center (FQHC) in Burgaw, NC

Q: What is Black River Health Services Inc's NPI number?

The NPI number for Black River Health Services Inc is 1093703886. It was assigned to this organization in the NPPES registry on October 6, 2005. The provider is doing business as Black River Family Practice.

Q: What is Black River Health Services Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Active since October 06, 2005CLIA 34D0245905 · Microscopy

301 S CAMPBELL ST, BURGAW, NC 28425(910) 259-5721(910) 259-8002 Get Directions Write a Review

NPPES record last updated: December 12, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Black River Family Practice NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACK RIVER FAMILY PRACTICE (NPI 1093703886) is a healthcare organization registered as a federally qualified health center (fqhc) in Burgaw, North Carolina and active in the NPI registry since October 2005. The organization holds a CLIA Microscopy certificate valid through March 7, 2027 and lists Lee Ann Amann, Administrator, as its authorized official.

NPPES Registry Identity

NPI1093703886

Entity TypeOrganization

Primary Taxonomy261QF0400X

Legal Business NameBLACK RIVER HEALTH SERVICES INC

Location Address301 S CAMPBELL STBurgaw, NC 28425-5011

Mailing Address301 S Campbell StBurgaw, NC 28425-5011 · (910) 259-6973 · Fax (910) 259-6975

Phone(910) 259-5721

Fax(910) 259-8002

Organization SubpartNo

Authorized OfficialLee Ann AmannAdministrator · (910) 259-6973

Enumeration DateOctober 6, 2005

Last NPPES UpdateDecember 12, 2019

✔ NPI 1093703886 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities

Taxonomy Code261QF0400X

Also ListedFamily MedicineTaxonomy 207Q00000X

Also ListedInternal MedicineTaxonomy 207R00000X

Also ListedClinic/Center · Rural HealthTaxonomy 261QR1300X

301 S CAMPBELL ST, Burgaw, NC 28425

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Other Names 1

Doing Business AsBlack River Family Practice

Other Identifiers 2

Medicaid343905ACNC

Other0104XBcbs

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, Ambetter of Tennessee and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 34D0245905

Black River Health Services Inc · Burgaw, NC

Active · expires Mar 7, 2027

CLIA Number34D0245905

Laboratory TypeCommunity Clinic

Certificate Effective DateMarch 8, 2025

Certificate Expiration DateMarch 7, 2027

Laboratory DirectorLinda Greenspan

Laboratory Phone(910) 259-5721

Laboratory LocationBlack River Health Services Inc301 S Campbell Street, Burgaw, NC 28425

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BLACK RIVER HEALTH SERVICES, INC.

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