Provider Demographics
NPI:1659482792
Name:RIVERBEND MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:RIVERBEND MEDICAL GROUP, INC
Other - Org Name:TRINITY HEALTH OF NEW ENGLAND MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:444 MONTGOMERY STREET
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1997
Mailing Address - Country:US
Mailing Address - Phone:413-523-0824
Mailing Address - Fax:413-523-0930
Practice Address - Street 1:444 MONTGOMERY STREET
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1997
Practice Address - Country:US
Practice Address - Phone:413-523-0824
Practice Address - Fax:413-523-0930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9782613Medicaid
MA9782613Medicaid
MAM20454Medicare ID - Type Unspecified