MEDICARE: RIVER MEDICAL INC

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	341600000X	Ambulance
2	3416L0300X	Land Ambulance	94	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316944846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER MEDICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 847102
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-7102
Country	:	US
Telephone Number	:	800-913-9106
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 EL CAMINO WAY
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-4628
Country	:	US
Telephone Number	:	928-855-0048
Fax Number	:	928-855-5419

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	TIMOTHY JOSEPH DORN
Credential	:
Telephone Number	:	833-703-2294

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/16/2025

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