Basic Information
Provider Information
NPI: 1487722674
EntityType: 2
ReplacementNPI:  
OrganizationName: RIVERVIEW CLINIC PSC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 105 MAIN ST
Address2:  
City: IRVINE
State: KY
PostalCode: 403361023
CountryCode: US
TelephoneNumber: 6067237771
FaxNumber: 6067234364
Practice Location
Address1: 105 MAIN ST
Address2:  
City: IRVINE
State: KY
PostalCode: 403361023
CountryCode: US
TelephoneNumber: 6067237771
FaxNumber: 6067234364
Other Information
ProviderEnumerationDate: 12/04/2006
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: PATTERSON
AuthorizedOfficialFirstName: JOHN
AuthorizedOfficialMiddleName: A.
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 6067237771
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
3500113005KY MEDICAID


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