MEDICARE: RIVER HEALTHCARE, 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	207Q00000X	Family Medicine Physician	10269R	LA
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine 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

General Provider Information

NPI Number	:	1649290578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER HEALTHCARE, INC

Provider Business Mailing Address
First Line	:	3515 HWY 1 SOUTH
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767
Country	:	US
Telephone Number	:	225-749-5750
Fax Number	:	225-749-3138

Provider Business Practice Location Address
First Line	:	3515 HWY 1 SOUTH
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767
Country	:	US
Telephone Number	:	225-749-5750
Fax Number	:	225-749-3138

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. MEICHI C. LEE
Credential	:
Telephone Number	:	225-749-5750

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	09/11/2025

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Directions to “RIVER HEALTHCARE, INC ” Practice Location

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