Provider Demographics
NPI:1891756870
Name:RIVER VALLEY PHYSICIANS, LLC
Entity Type:Organization
Organization Name:RIVER VALLEY PHYSICIANS, LLC
Other - Org Name:EAST LIVERPOOL PROFESSIONALS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-386-3610
Mailing Address - Street 1:PO BOX 2396
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-0396
Mailing Address - Country:US
Mailing Address - Phone:330-386-3610
Mailing Address - Fax:330-368-0005
Practice Address - Street 1:15655 STATE ROUTE 170
Practice Address - Street 2:
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9672
Practice Address - Country:US
Practice Address - Phone:330-386-3610
Practice Address - Fax:330-368-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2669232Medicaid
OH2669232Medicaid