Provider Demographics
NPI:1114235173
Name:PEPITO C & MINERVA C RIVERA PTR
Entity Type:Organization
Organization Name:PEPITO C & MINERVA C RIVERA PTR
Other - Org Name:RIVERA & CONCEPCION MED ASSOC PTSHP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GEN PTR
Authorized Official - Prefix:DR
Authorized Official - First Name:PEPITO
Authorized Official - Middle Name:C
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-258-3324
Mailing Address - Street 1:308 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:64628-1601
Mailing Address - Country:US
Mailing Address - Phone:660-258-3324
Mailing Address - Fax:660-258-3325
Practice Address - Street 1:308 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:MO
Practice Address - Zip Code:64628-1601
Practice Address - Country:US
Practice Address - Phone:660-258-3324
Practice Address - Fax:660-258-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty