Provider Demographics
NPI:1437288255
Name:RIVERTOWN RHEUMATOLOGY P.C.
Entity Type:Organization
Organization Name:RIVERTOWN RHEUMATOLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RHEUMATOLOGIST/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:MEADOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:706-494-8444
Mailing Address - Street 1:700 CENTER ST
Mailing Address - Street 2:STE 303
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31902-1566
Mailing Address - Country:US
Mailing Address - Phone:706-494-8444
Mailing Address - Fax:
Practice Address - Street 1:700 CENTER ST
Practice Address - Street 2:STE 303
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1546
Practice Address - Country:US
Practice Address - Phone:706-494-8444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043709207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000750373CMedicaid
GA000750373CMedicaid
GAGRP4761Medicare PIN