Provider Demographics
NPI:1083651814
Name:RIVER ROAD MEDICAL GROUP
Entity Type:Organization
Organization Name:RIVER ROAD MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-688-0674
Mailing Address - Street 1:890 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3233
Mailing Address - Country:US
Mailing Address - Phone:541-688-0674
Mailing Address - Fax:541-688-5378
Practice Address - Street 1:890 RIVER RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97404-3233
Practice Address - Country:US
Practice Address - Phone:541-688-0674
Practice Address - Fax:541-688-5378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227012Medicaid
OR058869000OtherBLUE CROSS BLUE SHIELD
ORCC7608OtherRAILROAD MEDICARE
ORCC7608OtherRAILROAD MEDICARE