Provider Demographics
NPI:1669957031
Name:RIVER MEDICAL HEALTHCARE LLC
Entity type:Organization
Organization Name:RIVER MEDICAL HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-335-0183
Mailing Address - Street 1:PO BOX 5368
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38704-5368
Mailing Address - Country:US
Mailing Address - Phone:662-390-8992
Mailing Address - Fax:
Practice Address - Street 1:2119 HIGHWAY 82 E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-6010
Practice Address - Country:US
Practice Address - Phone:662-390-8992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty