Provider Demographics
NPI:1912992421
Name:FOUR RIVERS INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:FOUR RIVERS INTERNAL MEDICINE, PLLC
Other - Org Name:DRS BASSI AND LORCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-444-8000
Mailing Address - Street 1:3131 PARISA DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-4584
Mailing Address - Country:US
Mailing Address - Phone:270-444-8000
Mailing Address - Fax:270-444-8302
Practice Address - Street 1:3131 PARISA DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-4584
Practice Address - Country:US
Practice Address - Phone:270-444-8000
Practice Address - Fax:270-444-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21063207R00000X
KY6224S363LF0000X
KY5660P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65904781Medicaid
KY65904781Medicaid
KYCH0308Medicare PIN
C74188Medicare UPIN
KY6390Medicare PIN