Organization Name: | RIVER VALLEY MEDICAL CENTER FAMILY CLINIC LLC |
NPI Number: | 1245437490 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROCK BORDELON (CEO PRESIDENT) |
Mailing Address: | 1652 State Highway 22 W Dardanelle |
State: | AR US |
Postal Code: | 728342909 |
Phone Number: | 3186295321 |
Fax Number: | 3186295321 |
NPI Enumeration Date: | 06/29/2007 |
NPI Last Update Date: | 08/03/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |