Provider Demographics
NPI:1952503773
Name:RIVERVIEW FAMILY MEDICINE AND URGENT CARE CENTER
Entity Type:Organization
Organization Name:RIVERVIEW FAMILY MEDICINE AND URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:JEFFERY
Authorized Official - Last Name:GUEVARA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-767-1500
Mailing Address - Street 1:3945 US HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-4531
Mailing Address - Country:US
Mailing Address - Phone:361-767-1500
Mailing Address - Fax:361-767-1556
Practice Address - Street 1:3945 US HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-4531
Practice Address - Country:US
Practice Address - Phone:361-767-1500
Practice Address - Fax:361-767-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXH10849Medicare UPIN
TX00333XMedicare ID - Type UnspecifiedMCR GROUP