Provider Demographics
NPI:1649322215
Name:RIVER CITY MEDICAL ASSOCIATES INC
Entity type:Organization
Organization Name:RIVER CITY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:RASIKLAL
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-743-2222
Mailing Address - Street 1:6947 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2684
Mailing Address - Country:US
Mailing Address - Phone:904-743-2222
Mailing Address - Fax:904-743-3087
Practice Address - Street 1:6947 MERRILL RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2684
Practice Address - Country:US
Practice Address - Phone:904-743-2222
Practice Address - Fax:904-743-3087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8351111N00000X
FLCH9130111N00000X
FLCH8829111N00000X
FLCH10260111N00000X
FLCH10561111N00000X
FLME121788207R00000X, 261QP2300X
FLME802122081P2900X
FLME1019992081P2900X
FLME103267208VP0000X, 208VP0014X
261Q00000X, 261QP3300X
FL261QP2000X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011041800Medicaid
FL33125OtherBLUE CROSS BLUE SHIELD FL
FLDO0093OtherRAILROAD
FL011041800Medicaid
FL350056717OtherMEDICARE RAILROAD