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General NPI Number Information
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NPI Number | 1558508028
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Entity Type | Organization
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Legal Business Name | RIVER PARK PHYSICIAN GROUP LLC
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 1589 SPARTA STREET
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City | MC MINNVILLE
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State | TN
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Zip | 37110-1392
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Country | US
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Telephone | 931-815-4101
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Fax | 931-815-4640
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Provider Business Mailing Address
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Address Line | 1559 SPARTA STREET
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City | MCMINNVILLE
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State | TN
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Zip | 37110-1392
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Country | US
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Telephone | 931-815-4101
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Fax | 931-815-4640
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Authorized Official
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Title or Position | CEO
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Name | MR. DANIEL S. SLIPKOVICH
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Credential |
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Telephone | 615-764-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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