Healthcare Provider Details

I. General information

NPI: 1538300686
Provider Name (Legal Business Name): RIVER CITY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7311 GREENHAVEN DRIVE SUITE 145
SACRAMENTO CA
95831-3589
US

IV. Provider business mailing address

7311 GREENHAVEN DR STE 145
SACRAMENTO CA
95831-3595
US

V. Phone/Fax

Practice location:
  • Phone: 916-228-4300
  • Fax: 916-424-6200
Mailing address:
  • Phone: 916-228-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number302F00000X
License Number StateCA

VIII. Authorized Official

Name: MISS AMY CLOTHIER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 916-228-4300