MEDICARE: RIVER VALLEY EMERGENCY PHYSICIANS

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	146D00000X	Personal Emergency Response Attendant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5B194	OTHER	AR	BCBS GROUP NUMBER

General Provider Information

NPI Number	:	1710929518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER VALLEY EMERGENCY PHYSICIANS

Provider Business Mailing Address
First Line	:	2609 MILITARY RD
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-2717
Country	:	US
Telephone Number	:	501-315-6500
Fax Number	:	501-315-0006

Provider Business Practice Location Address
First Line	:	2609 MILITARY RD
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-2717
Country	:	US
Telephone Number	:	501-315-6500
Fax Number	:	501-315-0006

Authorized Official
Title or Position	:	BUSINESS OFFICE MANAGER
Name	:	LINDA MCCALL
Credential	:
Telephone Number	:	501-315-6500

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	08/22/2020

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