Provider Demographics
NPI:1265422968
Name:RIVERVIEW HOSPITAL
Entity type:Organization
Organization Name:RIVERVIEW HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCIARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-773-0760
Mailing Address - Street 1:2749 E COVENANTER DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5454
Mailing Address - Country:US
Mailing Address - Phone:812-332-2265
Mailing Address - Fax:812-334-0853
Practice Address - Street 1:937 FRY RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1820
Practice Address - Country:US
Practice Address - Phone:317-881-3535
Practice Address - Fax:317-881-4038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-24
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN352093620314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100266620BMedicaid
IN155412Medicare Oscar/Certification