Provider Demographics
NPI:1912670308
Name:RIVER CITY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:RIVER CITY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER & LEGAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:YAMASHITA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-228-4300
Mailing Address - Street 1:7311 GREENHAVEN DR STE 165
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3587
Mailing Address - Country:US
Mailing Address - Phone:916-733-6870
Mailing Address - Fax:916-451-0402
Practice Address - Street 1:7311 GREENHAVEN DR STE 165
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3587
Practice Address - Country:US
Practice Address - Phone:916-733-6870
Practice Address - Fax:916-451-0402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIVER CITY MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty