Provider Demographics
NPI:1831452994
Name:RIVER HOSPITAL, INC.
Entity type:Organization
Organization Name:RIVER HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, REVENUE CYCLE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:BOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-482-1207
Mailing Address - Street 1:4 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13607-1316
Mailing Address - Country:US
Mailing Address - Phone:315-482-2511
Mailing Address - Fax:315-482-4981
Practice Address - Street 1:4 FULLER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1391
Practice Address - Country:US
Practice Address - Phone:315-482-1207
Practice Address - Fax:315-482-3727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03011387Medicaid
NY02392854Medicaid
NY1367324943OtherHPSA
NY02381OtherHPSA ID MUA
NY33D1050774OtherCLIA