Healthcare Provider Details

I. General information

NPI: 1366550956
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

2727 W CAPITOL AVE
WEST SACRAMENTO CA
95691-2220
US

IV. Provider business mailing address

PO BOX 15470
SACRAMENTO CA
95851-0470
US

V. Phone/Fax

Practice location:
  • Phone: 916-371-2275
  • Fax: 916-371-8649
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 Number5641
License Number StateCA

VIII. Authorized Official

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