MEDICARE: RIVERBEND FAMILY MEDICINE PC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1578646774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERBEND FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	406 TAYLOR ST STE A
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-1050
Fax Number	:	256-574-1045

Provider Business Practice Location Address
First Line	:	406 TAYLOR ST STE A
Second Line	:
City	:	SCOTTSBORO
State	:	AL
Zip	:	35768-2406
Country	:	US
Telephone Number	:	256-574-1050
Fax Number	:	256-574-1045

Authorized Official
Title or Position	:	BILLING MGR
Name	:	MONICA COPELAND
Credential	:
Telephone Number	:	256-532-1888

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	11/20/2007

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