Provider Demographics
NPI:1235362427
Name:NEW RIVER MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:NEW RIVER MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-566-1330
Mailing Address - Street 1:800 NE 62ND ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3522
Mailing Address - Country:US
Mailing Address - Phone:954-771-8903
Mailing Address - Fax:954-771-8905
Practice Address - Street 1:800 NE 62ND ST
Practice Address - Street 2:SUITE 204
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-3522
Practice Address - Country:US
Practice Address - Phone:954-771-8903
Practice Address - Fax:954-771-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory