Provider Demographics
NPI:1033171327
Name:RIVERBEND FAMILY MEDICINE, PA
Entity Type:Organization
Organization Name:RIVERBEND FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OFFICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-577-9952
Mailing Address - Street 1:1006 PROCURE ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526
Mailing Address - Country:US
Mailing Address - Phone:919-577-9952
Mailing Address - Fax:919-577-9946
Practice Address - Street 1:1006 PROCURE ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526
Practice Address - Country:US
Practice Address - Phone:919-577-9952
Practice Address - Fax:919-577-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0251VOtherSTATE OF NC HEALTH PLAN
NC0251VOtherBCBSNC
NC0251VOtherBCBSNC