Healthcare Provider Details

I. General information

NPI: 1144218413
Provider Name (Legal Business Name): RIVERVIEW FAMILY PRACTICE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 S WATER ST
LOUISA KY
41230-1387
US

IV. Provider business mailing address

203 S WATER ST PO BOX 120
LOUISA KY
41230-1387
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-4504
  • Fax: 606-638-4186
Mailing address:
  • Phone: 606-638-4504
  • Fax: 606-638-4186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK B KINGSTON
Title or Position: CLINIC DIRECTOR
Credential: MD
Phone: 606-638-4504