MEDICARE: RIVERVIEW FAMILY MEDICINE, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1730740333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW FAMILY MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2450 INDIA HOOK RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3270
Country	:	US
Telephone Number	:	803-366-7443
Fax Number	:	803-329-1118

Provider Business Practice Location Address
First Line	:	2450 INDIA HOOK RD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-3270
Country	:	US
Telephone Number	:	803-366-7443
Fax Number	:	803-329-1118

Authorized Official
Title or Position	:	BILLING OFFICE SUPERVISOR
Name	:	JESSICA MCKENZIE
Credential	:
Telephone Number	:	803-366-7443

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	05/29/2026

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