Basic Information
| Provider Information | |||||||||
| NPI: | 1710307582 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPRING RIVER MENTAL HEALTH AND WELLNESS INC | ||||||||
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| OtherOrganizationName: | SPRING RIVER MEDICAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667700550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208482380 | ||||||||
| FaxNumber: | 6208482381 | ||||||||
| Practice Location | |||||||||
| Address1: | 6524 SE QUAKERVALE RD | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667704214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208482380 | ||||||||
| FaxNumber: | 6208482381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2014 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | JACKSON | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6208482300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.