1336108893 NPI number — DR. CAROLE YVONNE RIVERS MD

Table of content: DR. CAROLE YVONNE RIVERS MD (NPI 1336108893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336108893 NPI number — DR. CAROLE YVONNE RIVERS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIVERS
Provider First Name:
CAROLE
Provider Middle Name:
YVONNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIVERS
Provider Other First Name:
CAROLE
Provider Other Middle Name:
WEATHERLY (MAIDEN)
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1336108893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 TUNNEL RD
Provider Second Line Business Mailing Address:
#116
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28805-2043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-299-2519
Provider Business Mailing Address Fax Number:
828-299-5992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 TUNNEL RD
Provider Second Line Business Practice Location Address:
#116
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28805-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-299-2519
Provider Business Practice Location Address Fax Number:
828-299-5992
Provider Enumeration Date:
03/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  9300576 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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