Provider Demographics
NPI:1093863417
Name:RIVERVIEW REGIONAL MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:RIVERVIEW REGIONAL MEDICAL CENTER, LLC
Other - Org Name:RIVERVIEW IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR. VP AND GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRY
Authorized Official - Suffix:IV
Authorized Official - Credentials:ESQ
Authorized Official - Phone:239-598-3176
Mailing Address - Street 1:1423 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5397
Mailing Address - Country:US
Mailing Address - Phone:256-549-0014
Mailing Address - Fax:
Practice Address - Street 1:1423 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5397
Practice Address - Country:US
Practice Address - Phone:256-549-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05155280Medicare Oscar/Certification