Healthcare Provider Details

I. General information

NPI: 1346338704
Provider Name (Legal Business Name): RIVER VALLEY ORTHOPEDICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LAFAYETTE AVE SE 4TH FLOOR
GRAND RAPIDS MI
49503-4600
US

IV. Provider business mailing address

1111 LEFFINGWELL AVE NE
GRAND RAPIDS MI
49525-6406
US

V. Phone/Fax

Practice location:
  • Phone: 616-456-8515
  • Fax: 616-456-8208
Mailing address:
  • Phone: 616-459-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOEL YOUNG
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 616-459-7101