MEDICARE: RIVERVIEW HOSPITAL

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	314000000X	Skilled Nursing Facility		IN

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

General Provider Information

NPI Number	:	1437266939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	359 RANDOLPH STREET
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368
Country	:	US
Telephone Number	:	765-468-8280
Fax Number	:	765-468-8580

Provider Business Practice Location Address
First Line	:	359 RANDOLPH STREET
Second Line	:
City	:	PARKER CITY
State	:	IN
Zip	:	47368
Country	:	US
Telephone Number	:	765-468-8280
Fax Number	:	765-468-8580

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GARY OTT
Credential	:
Telephone Number	:	765-664-5400

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	08/01/2014

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Directions to “RIVERVIEW HOSPITAL ” Practice Location

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