MEDICARE: RIVERSIDE MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053145730
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	1900 MAIN ST
Second Line	:
City	:	FRANKLINTON
State	:	LA
Zip	:	70438-3688
Country	:	US
Telephone Number	:	985-839-4431
Fax Number	:	985-795-0876

Provider Business Practice Location Address
First Line	:	806 A RIVERSIDE DR
Second Line	:
City	:	FRANKLINTON
State	:	LA
Zip	:	70438-3603
Country	:	US
Telephone Number	:	985-839-4431
Fax Number	:	985-795-0876

Authorized Official
Title or Position	:	CEO
Name	:	DARRELL LEE LAVENDER
Credential	:
Telephone Number	:	985-795-4148

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	08/27/2024

Similar Medicare Providers

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Practice Location Address:

806B RIVERSIDE DR
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70438-3603

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1922001890 — DR. THOMAS EDWARD BOWDEN JR. M.D.
Practice Location Address:

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Practice Location Address:

1900 MAIN ST
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1194721266 — DR. CONRAD PETTIT MCVEA III DDS
Practice Location Address:

2016 WASHINGTON ST
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1356347249 — DR. CONRAD PETTIT MCVEA JR. DDS
Practice Location Address:

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1700874062 — RIVERSIDE MEDICAL CENTER
Practice Location Address:

1900 MAIN ST
FRANKLINTON, LA
70438-3688

Practice Phone: 985-839-4431
Practice Fax: 985-839-0319

Directions to “RIVERSIDE MEDICAL CENTER ” Practice Location

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