Provider Demographics
NPI:1629062336
Name:RIVER CITY ORTHOPAEDICS AND SPINE MEDICINE CENTER PC
Entity Type:Organization
Organization Name:RIVER CITY ORTHOPAEDICS AND SPINE MEDICINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER FOUNDER CEO MD
Authorized Official - Prefix:
Authorized Official - First Name:EMORY
Authorized Official - Middle Name:JEVODE
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-653-6635
Mailing Address - Street 1:1900 10TH AVE
Mailing Address - Street 2:STE 320
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-3600
Mailing Address - Country:US
Mailing Address - Phone:706-653-6635
Mailing Address - Fax:706-653-8543
Practice Address - Street 1:1900 10TH AVE
Practice Address - Street 2:STE 320
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3600
Practice Address - Country:US
Practice Address - Phone:706-653-6635
Practice Address - Fax:706-653-8543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39717207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL92948OtherBLUE CROSS
GA00661922CMedicaid
F60323Medicare UPIN
GA00661922CMedicaid