MEDICARE: MRS. TIERRA S RIVERS

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	1744P3200X	Prosthetics Case Management	76417	SC

General Provider Information

NPI Number	:	1144839101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIERRA S RIVERS

Provider Business Mailing Address
First Line	:	2702 W SURREY DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5513
Country	:	US
Telephone Number	:	843-817-6803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 W SURREY DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29405-5513
Country	:	US
Telephone Number	:	843-817-6803
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2020
Last Update Date	:	12/26/2024

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