Healthcare Provider Details

I. General information

NPI: 1700874062
Provider Name (Legal Business Name): RIVERSIDE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MAIN ST
FRANKLINTON LA
70438-3688
US

IV. Provider business mailing address

1900 MAIN ST
FRANKLINTON LA
70438-3688
US

V. Phone/Fax

Practice location:
  • Phone: 985-839-4431
  • Fax: 985-839-0319
Mailing address:
  • Phone: 985-839-4431
  • Fax: 985-839-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number168
License Number StateLA

VIII. Authorized Official

Name: STACEY K MCGRAW
Title or Position: BUSINESS OFFICE DIRECTOR
Credential:
Phone: 985-795-4168