Provider Demographics
NPI:1154664274
Name:RIVER VALLEY CLINIC, PC
Entity Type:Organization
Organization Name:RIVER VALLEY CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEPEL
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MPAS
Authorized Official - Phone:406-433-7300
Mailing Address - Street 1:PO BOX 1347
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-1347
Mailing Address - Country:US
Mailing Address - Phone:406-433-7300
Mailing Address - Fax:406-433-7310
Practice Address - Street 1:813 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4940
Practice Address - Country:US
Practice Address - Phone:406-433-7300
Practice Address - Fax:406-433-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care