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NPI Code Detail

MEDICARE: RIVER VALLEY MEDICAL CENTER FAMILY CLINIC LLC

MEDICARE: RIVER VALLEY MEDICAL CENTER FAMILY CLINIC LLC
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
1261QR1300XRural Health Clinic/Center

General Provider Information

NPI Number : 1245437490
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVER VALLEY MEDICAL CENTER FAMILY CLINIC LLC
Provider Business Mailing Address
First Line : 504 TEXAS ST STE 200
Second Line :
City : SHREVEPORT
State : LA
Zip : 71101-3526
Country : US
Telephone Number : 318-629-5321
Fax Number : 318-226-2805
Provider Business Practice Location Address
First Line : 1652 STATE HIGHWAY 22 W
Second Line :
City : DARDANELLE
State : AR
Zip : 72834-2909
Country : US
Telephone Number : 318-629-5321
Fax Number : 318-629-5321
Authorized Official
Title or Position : CEO PRESIDENT
Name : MR. ROCK BORDELON
Credential :
Telephone Number : 318-226-8202
Provider Enumeration Date : 06/29/2007
Last Update Date : 08/03/2007

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Directions to “RIVER VALLEY MEDICAL CENTER FAMILY CLINIC LLC ” Practice Location

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