Provider Demographics
NPI:1063653327
Name:RIVER CITY FAMILY HEALTH
Entity Type:Organization
Organization Name:RIVER CITY FAMILY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENI
Authorized Official - Middle Name:R
Authorized Official - Last Name:LLOVET
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:406-541-8090
Mailing Address - Street 1:742 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5720
Mailing Address - Country:US
Mailing Address - Phone:406-541-8090
Mailing Address - Fax:406-541-8093
Practice Address - Street 1:742 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5720
Practice Address - Country:US
Practice Address - Phone:406-541-8090
Practice Address - Fax:406-541-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-17
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15532363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty