MEDICARE: RIVERVIEW HOSPITAL

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	314000000X	Skilled Nursing Facility	050001441	IN

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	:	1932175791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERVIEW HOSPITAL

Provider Business Mailing Address
First Line	:	3249 E COVENANTER DR
Second Line	:
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5479
Country	:	US
Telephone Number	:	812-332-2265
Fax Number	:	812-334-0854

Provider Business Practice Location Address
First Line	:	COUNTY ROAD 800 WEST
Second Line	:
City	:	LYONS
State	:	IN
Zip	:	47443-0247
Country	:	US
Telephone Number	:	812-659-1440
Fax Number	:	812-659-9995

Authorized Official
Title or Position	:	PRESIDENT CEO
Name	:	DR. STEPHEN G. MOORE
Credential	:	MD
Telephone Number	:	812-332-2265

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	12/06/2011

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Directions to “RIVERVIEW HOSPITAL ” Practice Location

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