| Organization Name: | BLACK RIVER MEMORIAL HOSPITAL INC |
| NPI Number: | 1285782250 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY BETH WHITE-JACOBS (PRESIDENT & CEO) |
| Mailing Address: | 711 W Adams St Black River Falls |
| State: | WI US |
| Postal Code: | 546159108 |
| Phone Number: | 7152845361 |
| Fax Number: | 7152841398 |
| NPI Enumeration Date: | 01/08/2007 |
| NPI Last Update Date: | 07/08/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BX2000X |
| License Number: | 1037 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Oxygen Equipment & Supplies |
| Taxonomy Definition: | |