Provider Demographics
NPI:1932158938
Name:RIVERWOOD MEDICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:RIVERWOOD MEDICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-854-8202
Mailing Address - Street 1:3715 UNION RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8044
Mailing Address - Country:US
Mailing Address - Phone:704-854-8202
Mailing Address - Fax:
Practice Address - Street 1:3715 UNION RD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-8044
Practice Address - Country:US
Practice Address - Phone:704-854-8202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36757207Q00000X
NC9400760207Q00000X
NC200101147207Q00000X
NC200001505207Q00000X
NC9401016207R00000X
NC100796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1841257540OtherNPI ENUMERATOR
NC1336106038OtherNPI ENUMERATOR
NC1457318156OtherNPI ENUMERATOR
NC1720045958OtherNPI ENUMERATOR
NC1497712277OtherNPI ENUMERATOR
NC1720045958OtherNPI ENUMERATOR