Basic Information
| Provider Information | |||||||||
| NPI: | 1710929518 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RIVER VALLEY EMERGENCY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2609 MILITARY RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720152717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013156500 | ||||||||
| FaxNumber: | 5013150006 | ||||||||
| Practice Location | |||||||||
| Address1: | 2609 MILITARY RD | ||||||||
| Address2: | |||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720152717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013156500 | ||||||||
| FaxNumber: | 5013150006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCALL | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5013156500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | 5B194 | 01 | AR | BCBS GROUP NUMBER | OTHER |