Provider Demographics
NPI:1790718724
Name:RIVER VALLEY IMAGING, LLC
Entity Type:Organization
Organization Name:RIVER VALLEY IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-537-8105
Mailing Address - Street 1:7800 E KEMPER RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1664
Mailing Address - Country:US
Mailing Address - Phone:513-530-9200
Mailing Address - Fax:513-530-0555
Practice Address - Street 1:600 WILSON CREEK RD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-2751
Practice Address - Country:US
Practice Address - Phone:812-537-8105
Practice Address - Fax:812-537-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044388A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2611696Medicaid
IN200105380Medicaid
IN172710Medicare PIN
KY172710Medicare PIN