Provider Demographics
NPI:1578646774
Name:RIVERBEND FAMILY MEDICINE PC
Entity Type:Organization
Organization Name:RIVERBEND FAMILY MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-532-1888
Mailing Address - Street 1:406 TAYLOR ST STE A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-2406
Mailing Address - Country:US
Mailing Address - Phone:256-574-1050
Mailing Address - Fax:256-574-1045
Practice Address - Street 1:406 TAYLOR ST STE A
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-2406
Practice Address - Country:US
Practice Address - Phone:256-574-1050
Practice Address - Fax:256-574-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ122Medicare PIN