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General NPI Number Information
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NPI Number | 1235362427
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Entity Type | Organization
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Legal Business Name | NEW RIVER MEDICAL GROUP LLC
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 800 NE 62ND ST SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-771-8903
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Fax | 954-771-8905
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Provider Business Mailing Address
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Address Line | 800 NE 62ND ST SUITE 204
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City | FORT LAUDERDALE
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State | FL
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Zip | 33334-3522
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Country | US
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Telephone | 954-771-8903
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Fax | 954-771-8905
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Authorized Official
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Title or Position | CEO
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Name | MR. WILLIAM WESLEY SHELTON
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Credential |
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Telephone | 954-566-1330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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