Provider Demographics
NPI:1780811612
Name:THE RIVERSONG CENTER OF INTEGRATIVE MEDICINE INC
Entity type:Organization
Organization Name:THE RIVERSONG CENTER OF INTEGRATIVE MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COMPANY PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-534-8000
Mailing Address - Street 1:1210 EAST 32ND ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-534-8000
Mailing Address - Fax:575-534-8002
Practice Address - Street 1:1210 EAST 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-534-8000
Practice Address - Fax:575-534-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization