Healthcare Provider Details

I. General information

NPI: 1902873961
Provider Name (Legal Business Name): ALVIN RIVERS IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 MARBLE COURT
JACKSONVILLE NC
28546
US

IV. Provider business mailing address

110 MARBLE CT
JACKSONVILLE NC
28546-9552
US

V. Phone/Fax

Practice location:
  • Phone: 910-381-3537
  • Fax:
Mailing address:
  • Phone: 910-381-3537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: