Provider Demographics
NPI:1134223795
Name:RIVERBEND MEDICAL GROUP, INC
Entity type:Organization
Organization Name:RIVERBEND MEDICAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-714-4396
Mailing Address - Street 1:230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1838
Mailing Address - Country:US
Mailing Address - Phone:413-789-6800
Mailing Address - Fax:413-789-5171
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001
Practice Address - Country:US
Practice Address - Phone:413-789-6800
Practice Address - Fax:413-789-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110113650/AMedicaid
MA5315780003Medicare NSC
MA110113650/AMedicaid