Provider Demographics
NPI:1093902942
Name:RIVERVIEW FAMILY MEDICINE LLC
Entity Type:Organization
Organization Name:RIVERVIEW FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEXTER
Authorized Official - Middle Name:M
Authorized Official - Last Name:GENSOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-592-0800
Mailing Address - Street 1:1600 E RIVERVIEW AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:NAPOLEON
Mailing Address - State:OH
Mailing Address - Zip Code:43545-9806
Mailing Address - Country:US
Mailing Address - Phone:419-592-0800
Mailing Address - Fax:419-592-0815
Practice Address - Street 1:1600 E RIVERVIEW AVE STE 107
Practice Address - Street 2:
Practice Address - City:NAPOLEON
Practice Address - State:OH
Practice Address - Zip Code:43545-9806
Practice Address - Country:US
Practice Address - Phone:419-592-0800
Practice Address - Fax:419-592-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079093261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942319652OtherNPI FOR D M GENSOLIN