Provider Demographics
NPI:1376035543
Name:NORTH RIVER INTERNAL MEDICINE
Entity Type:Organization
Organization Name:NORTH RIVER INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-764-2362
Mailing Address - Street 1:1110 DR. EDWARD HILLARD DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-7446
Mailing Address - Country:US
Mailing Address - Phone:205-333-4655
Mailing Address - Fax:205-333-4660
Practice Address - Street 1:100 RICE MINE RD N SUITE 150
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2375
Practice Address - Country:US
Practice Address - Phone:205-764-2362
Practice Address - Fax:205-333-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-04
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL216168Medicaid
AL222956Medicaid
AL216663Medicaid