Healthcare Provider Details

I. General information

NPI: 1568533388
Provider Name (Legal Business Name): RIVER VIEW EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BAILEY AVE
NEEDLES CA
92363-3103
US

IV. Provider business mailing address

PO BOX 7388
PHILADELPHIA PA
19101-7388
US

V. Phone/Fax

Practice location:
  • Phone: 760-326-7194
  • Fax:
Mailing address:
  • Phone: 805-563-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. CHARLES T MITCHELL
Title or Position: GENERAL PARTNER
Credential: MD
Phone: 805-563-3011