Provider Demographics
NPI:1467493825
Name:RIVER VALLEY PEDIATRICS LLC
Entity Type:Organization
Organization Name:RIVER VALLEY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FLOYD
Authorized Official - Last Name:CLARDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-794-9000
Mailing Address - Street 1:1513 JENNY LIND RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-5646
Mailing Address - Country:US
Mailing Address - Phone:479-784-9000
Mailing Address - Fax:479-784-9011
Practice Address - Street 1:1513 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-5646
Practice Address - Country:US
Practice Address - Phone:479-784-9000
Practice Address - Fax:479-784-9011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMC-2275261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center