Provider Demographics
NPI:1508927559
Name:RIVERVIEW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:RIVERVIEW HOSPITAL ASSOCIATION
Other - Org Name:RIVERVIEW FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PFS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-422-7739
Mailing Address - Street 1:1160 ROME CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NEKOOSA
Mailing Address - State:WI
Mailing Address - Zip Code:54457-8705
Mailing Address - Country:US
Mailing Address - Phone:715-325-7422
Mailing Address - Fax:
Practice Address - Street 1:1015 ANGELUS DR
Practice Address - Street 2:
Practice Address - City:NEKOOSA
Practice Address - State:WI
Practice Address - Zip Code:54457-1617
Practice Address - Country:US
Practice Address - Phone:715-886-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32844400Medicaid
WI32844400Medicaid