MEDICARE: RIVERVIEW MEDICAL SUPPLIES, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1598131435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW MEDICAL SUPPLIES, LLC

Provider Business Mailing Address
First Line	:	10732 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-677-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	10732 KETCHUM VALLEY DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-7185
Country	:	US
Telephone Number	:	813-677-2700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEVE J MINAFRI
Credential	:
Telephone Number	:	813-667-2700

Provider Enumeration Date	:	08/14/2015
Last Update Date	:	08/14/2015

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