Basic Information
| Provider Information | |||||||||
| NPI: | 1528371648 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERVIEW PEDIATRICS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 18TH ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044221133 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 18TH ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PARKERSBURG | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261013231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044221133 | ||||||||
| FaxNumber: | 3044854466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2010 | ||||||||
| LastUpdateDate: | 07/18/2010 | ||||||||
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| AuthorizedOfficialLastName: | WOLFE | ||||||||
| AuthorizedOfficialFirstName: | BRETT | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3044221133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2335 | WV | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.