Healthcare Provider Details

I. General information

NPI: 1487348389
Provider Name (Legal Business Name): WILDFLOWER RIVERHOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 OLIVE ST
SAINT JOSEPH MO
64503-2443
US

IV. Provider business mailing address

3831 FREDERICK AVE # 106
SAINT JOSEPH MO
64506-3020
US

V. Phone/Fax

Practice location:
  • Phone: 816-273-5070
  • Fax: 816-273-5070
Mailing address:
  • Phone: 816-248-2144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICK E GAUME
Title or Position: OWNER
Credential:
Phone: 816-248-2144