1790718724 NPI number — RIVER VALLEY IMAGING, LLC

Table of content: (NPI 1790718724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790718724 NPI number — RIVER VALLEY IMAGING, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVER VALLEY IMAGING, LLC
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:
Provider Other Organization Name Type Code:
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:
1790718724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7800 E KEMPER RD
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45249-1664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-530-9200
Provider Business Mailing Address Fax Number:
513-530-0555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 WILSON CREEK RD
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-537-8105
Provider Business Practice Location Address Fax Number:
812-537-3240
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BOTSFORD
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-537-8105

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  01044388A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2611696 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200105380 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com