Provider Demographics
NPI:1609847284
Name:RIVER WEST, L.P.
Entity Type:Organization
Organization Name:RIVER WEST, L.P.
Other - Org Name:RIVER WEST MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VP, LICENSURE
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:FULNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-253-0771
Mailing Address - Street 1:2424 50TH STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412
Mailing Address - Country:US
Mailing Address - Phone:502-253-0771
Mailing Address - Fax:
Practice Address - Street 1:59355 RIVER WEST DR
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-6553
Practice Address - Country:US
Practice Address - Phone:225-687-9222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA399282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1760561Medicaid
61068OtherBCBS
LA1760561Medicaid
LA1760561Medicaid