MEDICARE: RIVERSIDE COUNTY REGIONAL MEDICAL CENTER

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	282N00000X	General Acute Care Hospital	69547	CA

General Provider Information

NPI Number	:	1609240407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE COUNTY REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1646 N PALM AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1922
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1646 N PALM AVE
Second Line	:
City	:	UPLAND
State	:	CA
Zip	:	91784-1922
Country	:	US
Telephone Number	:	909-579-9944
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DR. GREGORY PROUTY
Credential	:	PHARMD
Telephone Number	:	951-486-4000

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	11/18/2015

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