Healthcare Provider Details

I. General information

NPI: 1316191125
Provider Name (Legal Business Name): RIVER VALLEY ORTHOPEDICS & SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 LINCOLN WAY E
OSCEOLA IN
46561-2767
US

IV. Provider business mailing address

320 LINCOLN WAY E
OSCEOLA IN
46561-2767
US

V. Phone/Fax

Practice location:
  • Phone: 574-674-6700
  • Fax: 574-674-7171
Mailing address:
  • Phone: 574-674-6700
  • Fax: 574-674-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN M GRAHAM
Title or Position: PRESIDENT
Credential: DO
Phone: 574-674-6700