Provider Demographics
NPI:1285641811
Name:GENEVA FAMILY PRACTICE ASSOCIATES, S.C.
Entity Type:Organization
Organization Name:GENEVA FAMILY PRACTICE ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-232-1818
Mailing Address - Street 1:815 N RANDALL RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-1992
Mailing Address - Country:US
Mailing Address - Phone:630-232-1818
Mailing Address - Fax:630-232-1868
Practice Address - Street 1:815 N RANDALL RD
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:IL
Practice Address - Zip Code:60510-1992
Practice Address - Country:US
Practice Address - Phone:630-232-1818
Practice Address - Fax:630-232-1868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-047518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047518Medicaid
IL036047518Medicaid
ILC46123Medicare UPIN