Provider Demographics
NPI:1144218413
Name:RIVERVIEW FAMILY PRACTICE PSC
Entity Type:Organization
Organization Name:RIVERVIEW FAMILY PRACTICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-638-4504
Mailing Address - Street 1:203 S WATER ST
Mailing Address - Street 2:PO BOX 120
Mailing Address - City:LOUISA
Mailing Address - State:KY
Mailing Address - Zip Code:41230-1387
Mailing Address - Country:US
Mailing Address - Phone:606-638-4504
Mailing Address - Fax:606-638-4186
Practice Address - Street 1:203 S WATER ST
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:KY
Practice Address - Zip Code:41230-1387
Practice Address - Country:US
Practice Address - Phone:606-638-4504
Practice Address - Fax:606-638-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty