Provider Demographics
NPI:1538497474
Name:RIVERBARK INC
Entity Type:Organization
Organization Name:RIVERBARK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MANN
Authorized Official - Last Name:NETTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-884-2388
Mailing Address - Street 1:121 FATHER HUGO DR
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-4467
Mailing Address - Country:US
Mailing Address - Phone:864-884-2388
Mailing Address - Fax:
Practice Address - Street 1:9 BUENA VISTA WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6621
Practice Address - Country:US
Practice Address - Phone:864-884-2388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19398261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care