Basic Information
| Provider Information | |||||||||
| NPI: | 1518963834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIVERS | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774794728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16811 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2816904678 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 09/20/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | K2782 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8G9742 | 01 | TX | BC/BS PROVIDER NUMBER | OTHER | P01034616 | 01 | TX | RAILROAD MEDICARE | OTHER | 190714 | 01 | TX | AMERIGROUP NUMBER | OTHER | 3285310 | 01 | TX | AETNA HMO NUMBER | OTHER | 7050494 | 01 | TX | AETNA PPO NUMBER | OTHER | K2782 | 01 | TX | STATE LICENSE NUMBER | OTHER | 127640406 | 05 | TX | MEDICAID |