MEDICARE: RIVERVIEW HOSPITAL

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	314000000X	Skilled Nursing Facility	050004221	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000108756	OTHER	IN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578522439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	868 SOUTH WASHINGTON ST
Second Line	:
City	:	MORRISTOWN
State	:	IN
Zip	:	46161-9633
Country	:	US
Telephone Number	:	765-763-6012
Fax Number	:	765-763-7261

Provider Business Practice Location Address
First Line	:	868 SOUTH WASHINGTON ST
Second Line	:
City	:	MORRISTOWN
State	:	IN
Zip	:	46161-9633
Country	:	US
Telephone Number	:	765-763-6012
Fax Number	:	765-763-7261

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. STEPHEN MOORE
Credential	:	M.D.
Telephone Number	:	812-332-2265

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	04/06/2017

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Directions to “RIVERVIEW HOSPITAL ” Practice Location

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