Provider Demographics
NPI:1043411952
Name:RIVER CITY FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:RIVER CITY FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-943-2325
Mailing Address - Street 1:925 STEVENS DR STE 1B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3523
Mailing Address - Country:US
Mailing Address - Phone:509-943-2325
Mailing Address - Fax:509-943-3021
Practice Address - Street 1:925 STEVENS DR STE 1B
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3523
Practice Address - Country:US
Practice Address - Phone:509-943-2325
Practice Address - Fax:509-943-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000758213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8867685Medicare PIN