Healthcare Provider Details

I. General information

NPI: 1447709043
Provider Name (Legal Business Name): RIVER CITY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2016
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 MCINTOSH AVE
ORANGE PARK FL
32073-4831
US

IV. Provider business mailing address

339 MCINTOSH AVE
ORANGE PARK FL
32073-4831
US

V. Phone/Fax

Practice location:
  • Phone: 904-213-8277
  • Fax:
Mailing address:
  • Phone: 904-213-8277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS7069
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number3144892
License Number StateFL

VIII. Authorized Official

Name: DAVID SCOTT SCHEINER
Title or Position: AMBR
Credential: DO
Phone: 904-213-8277