Healthcare Provider Details

I. General information

NPI: 1730740333
Provider Name (Legal Business Name): RIVERVIEW FAMILY MEDICINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 INDIA HOOK RD
ROCK HILL SC
29732-3270
US

IV. Provider business mailing address

2450 INDIA HOOK RD
ROCK HILL SC
29732-3270
US

V. Phone/Fax

Practice location:
  • Phone: 803-366-7443
  • Fax: 803-329-1118
Mailing address:
  • Phone: 803-366-7443
  • Fax: 803-329-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JESSICA MCKENZIE
Title or Position: BILLING OFFICE SUPERVISOR
Credential:
Phone: 803-366-7443