Healthcare Provider Details

I. General information

NPI: 1609984202
Provider Name (Legal Business Name): RIVER CITY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD SUITE B
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

PO BOX 15470
SACRAMENTO CA
95851-0470
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-2229
  • Fax: 916-363-2440
Mailing address:
  • Phone: 916-228-4300
  • Fax: 916-382-4202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number100377
License Number StateCA

VIII. Authorized Official

Name: MR. KENDRICK QUE
Title or Position: ADMINISTRATOR
Credential:
Phone: 916-228-4300