Basic Information
| Provider Information | |||||||||
| NPI: | 1740548825 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVER VALLEY ORTHOPEDICS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 LAFAYETTE AVE SE FL 4 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495034656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164568515 | ||||||||
| FaxNumber: | 6162331108 | ||||||||
| Practice Location | |||||||||
| Address1: | 2373 64TH ST SW STE 2500 | ||||||||
| Address2: | |||||||||
| City: | BYRON CENTER | ||||||||
| State: | MI | ||||||||
| PostalCode: | 493157978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6164568515 | ||||||||
| FaxNumber: | 6162331108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2012 | ||||||||
| LastUpdateDate: | 10/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | YOUNG | ||||||||
| AuthorizedOfficialFirstName: | JOEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | REVENUE CYCLE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6164597101 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RIVER VALLEY ORTHOPEDICS, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MI | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.