Provider Demographics
NPI:1285820761
Name:RIVER PRIMARY CARE CENTER, INC
Entity Type:Organization
Organization Name:RIVER PRIMARY CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ERVILUS
Authorized Official - Suffix:
Authorized Official - Credentials:NPC
Authorized Official - Phone:856-966-8088
Mailing Address - Street 1:2809 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08105-4426
Mailing Address - Country:US
Mailing Address - Phone:856-966-8088
Mailing Address - Fax:856-966-8089
Practice Address - Street 1:2809 RIVER RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08105-4426
Practice Address - Country:US
Practice Address - Phone:856-966-8088
Practice Address - Fax:856-966-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN10322000163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty