Provider Demographics
NPI:1023086774
Name:RIVER CITIES CARDIOLOGY, MPC
Entity type:Organization
Organization Name:RIVER CITIES CARDIOLOGY, MPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:812-282-1617
Mailing Address - Street 1:207 SPARKS AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3739
Mailing Address - Country:US
Mailing Address - Phone:812-282-1617
Mailing Address - Fax:812-288-7625
Practice Address - Street 1:207 SPARKS AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-282-1617
Practice Address - Fax:812-288-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001187A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65912925Medicaid
INCA4519OtherRAILROAD MEDICARE
KY8385Medicare PIN
IN122000Medicare PIN