Provider Demographics
NPI:1972989713
Name:RIVERVIEW MEDICAL, INC
Entity Type:Organization
Organization Name:RIVERVIEW MEDICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MINAFRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-677-2700
Mailing Address - Street 1:10732 KETCHUM VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7185
Mailing Address - Country:US
Mailing Address - Phone:813-677-2700
Mailing Address - Fax:813-677-6355
Practice Address - Street 1:10732 KETCHUM VALLEY DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7185
Practice Address - Country:US
Practice Address - Phone:813-677-2700
Practice Address - Fax:813-677-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54579207R00000X
FLPA91008766363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIK501AMedicare PIN