Basic Information
Provider Information
NPI: 1023086774
EntityType: 2
ReplacementNPI:  
OrganizationName: RIVER CITIES CARDIOLOGY, MPC
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Mailing Information
Address1: 207 SPARKS AVE
Address2: SUITE 104
City: JEFFERSONVILLE
State: IN
PostalCode: 471303739
CountryCode: US
TelephoneNumber: 8122821617
FaxNumber: 8122887625
Practice Location
Address1: 207 SPARKS AVE
Address2: SUITE 104
City: JEFFERSONVILLE
State: IN
PostalCode: 471303739
CountryCode: US
TelephoneNumber: 8122821617
FaxNumber: 8122887625
Other Information
ProviderEnumerationDate: 03/09/2006
LastUpdateDate: 11/14/2007
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AuthorizedOfficialLastName: HUSSAIN
AuthorizedOfficialFirstName: MOHAMMED
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AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8122821617
IsSoleProprietor:  
IsOrganizationSubpart: N
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AuthorizedOfficialCredential: M. D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X50001187AINY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
6591292505KY MEDICAID
CA451901INRAILROAD MEDICAREOTHER


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