Provider Demographics
NPI:1649342015
Name:HEART SPECIALISTS OF SWVA PC
Entity type:Organization
Organization Name:HEART SPECIALISTS OF SWVA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-382-6711
Mailing Address - Street 1:1201 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1515
Mailing Address - Country:US
Mailing Address - Phone:540-382-6711
Mailing Address - Fax:540-382-6712
Practice Address - Street 1:1201 ELM STREET
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1515
Practice Address - Country:US
Practice Address - Phone:540-382-6711
Practice Address - Fax:540-382-6712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G09087Medicare UPIN
VA00V273H50Medicare ID - Type Unspecified