MEDICARE: RIVER CITIES COMMUNITY CLINIC INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	PENDING	AZ

General Provider Information

NPI Number	:	1144387713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITIES COMMUNITY CLINIC INC.

Provider Business Mailing Address
First Line	:	813 HANCOCK RD STE 2
Second Line	:
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5032
Country	:	US
Telephone Number	:	928-704-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 HANCOCK RD
Second Line	:	SUITE 2
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442-5032
Country	:	US
Telephone Number	:	928-704-9700
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MRS. CHRISTINE MARIE MAHLSTEDE
Credential	:
Telephone Number	:	928-704-9700

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	06/01/2010

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