Basic Information
| Provider Information | |||||||||
| NPI: | 1811918436 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERVIEW HEALTHCARE ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 S MINNESOTA ST | ||||||||
| Address2: | |||||||||
| City: | CROOKSTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567161601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2182819200 | ||||||||
| FaxNumber: | 2182819224 | ||||||||
| Practice Location | |||||||||
| Address1: | 1428 CENTRAL AVE NE | ||||||||
| Address2: | |||||||||
| City: | EAST GRAND FORKS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 567211605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187731390 | ||||||||
| FaxNumber: | 2187731762 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| AuthorizedOfficialLastName: | ARVIDSON | ||||||||
| AuthorizedOfficialFirstName: | BETTY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2182819756 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
ID Information
| ID | Type | State | Issuer | Description | 5548 | 01 | ND | BCBS | OTHER | 12898 | 05 | ND | MEDICAID | 244T9RI | 01 | MN | BCBS | OTHER | 973488300 | 05 | MN | MEDICAID |