MEDICARE: RIVER VALLEY GASTROENTEROLOGY, PLLC

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	207RG0100X	Gastroenterology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346016185
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER VALLEY GASTROENTEROLOGY, PLLC

Provider Business Mailing Address
First Line	:	9001 JENNY LIND RD STE 2
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-444-3566
Fax Number	:	479-316-4464

Provider Business Practice Location Address
First Line	:	9001 JENNY LIND RD STE 2
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72908-8629
Country	:	US
Telephone Number	:	479-444-3566
Fax Number	:	479-316-4464

Authorized Official
Title or Position	:	CEO
Name	:	HRAIR P SIMONIAN
Credential	:	MD
Telephone Number	:	479-444-3566

Provider Enumeration Date	:	12/04/2023
Last Update Date	:	02/20/2026

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