Healthcare Provider Details

I. General information

NPI: 1841367364
Provider Name (Legal Business Name): RIVER CITY PEDIATRICS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/15/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6401 POPLAR AVE SUITE 610
MEMPHIS TN
38119-4823
US

IV. Provider business mailing address

PO BOX 1000 DEPT. 378
MEMPHIS TN
38148-0378
US

V. Phone/Fax

Practice location:
  • Phone: 901-761-1280
  • Fax: 901-761-9347
Mailing address:
  • Phone: 901-757-2345
  • Fax: 901-757-9065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRYN L HARLOW
Title or Position: ACCOUNTS RECEIVABLE MANAGER
Credential:
Phone: 901-757-2345