Provider Demographics
NPI:1073019683
Name:FIVE RIVERS MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FIVE RIVERS MEDICAL CENTER INC
Other - Org Name:FIVE RIVERS ORTHOPEDICS AND SPORTS MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RADCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-892-6000
Mailing Address - Street 1:2801 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:AR
Mailing Address - Zip Code:72455-9436
Mailing Address - Country:US
Mailing Address - Phone:870-892-6000
Mailing Address - Fax:
Practice Address - Street 1:310 CAMP RD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72455-9131
Practice Address - Country:US
Practice Address - Phone:870-892-6265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty