MEDICARE: RIVER CITY MEDICAL ASSOCIATES, 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	174400000X	Specialist

General Provider Information

NPI Number	:	1720406267
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER CITY MEDICAL ASSOCIATES, INC

Provider Business Mailing Address
First Line	:	644 CESERY BLVD
Second Line	:	STE 330
City	:	JACKSONVILLE
State	:	FL
Zip	:	32211-7116
Country	:	US
Telephone Number	:	904-683-0394
Fax Number	:

Provider Business Practice Location Address
First Line	:	6947 MERRILL RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2684
Country	:	US
Telephone Number	:	904-743-2222
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. VIPUL PATEL
Credential	:	DC
Telephone Number	:	904-683-0394

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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Directions to “RIVER CITY MEDICAL ASSOCIATES, INC ” Practice Location

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