Provider Demographics
NPI:1578103230
Name:RIVERGATE MEDICAL, LLC
Entity Type:Organization
Organization Name:RIVERGATE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOBB
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:740-562-8996
Mailing Address - Street 1:1860 NEWARK RD
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-2632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:965 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-3049
Practice Address - Country:US
Practice Address - Phone:740-562-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center