1801957659 NPI number — RIVERVIEW HOSPITAL ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801957659 NPI number — RIVERVIEW HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW HOSPITAL ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RIVERVIEW FAMILY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801957659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 ANGELUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEKOOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54457-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-886-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 ROME CENTER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEKOOSA
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54457-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-325-7422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAMINSKI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR OF PFS
Authorized Official Telephone Number:
715-422-7739

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 32844400 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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