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	261QR1300X	Rural Health Clinic/Center

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	:	1518955541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE MEDICAL CENTER

Provider Business Mailing Address
First Line	:	806B RIVERSIDE DR
Second Line	:
City	:	FRANKLINTON
State	:	LA
Zip	:	70438-3603
Country	:	US
Telephone Number	:	985-839-3555
Fax Number	:	985-839-6320

Provider Business Practice Location Address
First Line	:	806B RIVERSIDE DR
Second Line	:
City	:	FRANKLINTON
State	:	LA
Zip	:	70438-3603
Country	:	US
Telephone Number	:	985-839-3555
Fax Number	:	985-839-6320

Authorized Official
Title or Position	:	BUSINESS OFFICE DIRECTOR
Name	:	STACEY K MCGRAW
Credential	:
Telephone Number	:	985-795-4168

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/19/2022

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Practice Location Address:

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Practice Location Address:

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Directions to “RIVERSIDE MEDICAL CENTER ” Practice Location

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