Provider Demographics
NPI:1346016185
Name:RIVER VALLEY GASTROENTEROLOGY, PLLC
Entity Type:Organization
Organization Name:RIVER VALLEY GASTROENTEROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HRAIR
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:SIMONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-651-1714
Mailing Address - Street 1:9001 JENNY LIND RD STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72908-8629
Mailing Address - Country:US
Mailing Address - Phone:479-444-3566
Mailing Address - Fax:479-316-4464
Practice Address - Street 1:9001 JENNY LIND RD STE 2
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72908-8629
Practice Address - Country:US
Practice Address - Phone:479-444-3566
Practice Address - Fax:479-316-4464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty