Provider Demographics
NPI:1417053042
Name:RIVERVIEW HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:RIVERVIEW HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-295-5505
Mailing Address - Street 1:1605 GRAND CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:WV
Mailing Address - Zip Code:26105
Mailing Address - Country:US
Mailing Address - Phone:304-295-5505
Mailing Address - Fax:304-295-0503
Practice Address - Street 1:1605 GRAND CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:WV
Practice Address - Zip Code:26105
Practice Address - Country:US
Practice Address - Phone:304-295-5505
Practice Address - Fax:304-295-0503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV702111N00000X
WV002160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV5723775OtherAETNA
WV7600003000Medicaid
WV275961OtherMAMSI
WV275961OtherOPTIMUM CHOICE INC
WVU74375OtherCARELINK
WVU74375OtherCARELINK
WVU74375Medicare UPIN
WV275961OtherOPTIMUM CHOICE INC