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General NPI Number Information
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NPI Number | 1114705340
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Entity Type | Organization
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Legal Business Name | RIVERSTONE MEDICAL LLC
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 6910 E 111TH PL S
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City | BIXBY
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State | OK
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Zip | 74008-2066
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Country | US
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Telephone | 918-955-9026
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Fax |
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Provider Business Mailing Address
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Address Line | 6910 E 111TH PL S
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City | BIXBY
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State | OK
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Zip | 74008-2066
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Country | US
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Telephone | 918-955-9026
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELISSA LUISKUTTY
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Credential | CCC-SLP
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Telephone | 918-955-9026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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