Provider Demographics
NPI:1821211335
Name:RIVERS FAMILY MEDICINE PA
Entity type:Organization
Organization Name:RIVERS FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-205-4302
Mailing Address - Street 1:1503 BUENOS AIRES BLVD
Mailing Address - Street 2:BLDG 110
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6821
Mailing Address - Country:US
Mailing Address - Phone:352-205-4302
Mailing Address - Fax:352-430-0468
Practice Address - Street 1:1503 BUENOS AIRES BLVD
Practice Address - Street 2:BLDG 110
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-6821
Practice Address - Country:US
Practice Address - Phone:352-205-4302
Practice Address - Fax:352-430-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3845OtherRR MEDICARE
ME88231OtherADVANTAGE CARE METCARE HE
1477589950OtherDR RIVERS PERSONAL NPI
U3334YOtherDR RIVERS PIN
5672594OtherCOVENTRY HEALTH CCN INSUR
P00289325OtherRR MEDICARE
52119OtherBC
=========OtherHUMANA INSURANCE
K9019Medicare ID - Type Unspecified
P00289325OtherRR MEDICARE