RIVERSIDE MEDICAL CLINIC (NPI# 1811206923) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811206923 |
| Entity Type | Organization |
| Organization Name | RIVERSIDE MEDICAL CLINIC |
| Practice Address |
803 Hwy 18 Lake City AR 72347-0505 |
| Mailing Address |
Po Box 910 Manila AR 72442-0910 |
| Practice Telephone | 8702371055 |
| Practice Fax Number | 8702371054 |
| Mailing Telephone | 8705613300 |
| Mailing Fax Number | 8705613307 |
| Enumeration Date | 2010-10-07 |
| Last Update Date | 2011-08-02 |
| Authorized Official Name | TOMMY WAGNER (OWNER) |
| Authorized Official Telephone | 8705613300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 187113002 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639274319 | Riverside Medical Clinic | Internal Medicine | 6250 Clay St, Riverside, CA 92509 | 2006-09-14 |
| 1548362973 | Riverside Medical Clinic | Internal Medicine | 830 Magnolia Ave, Corona, CA 92882 | 2006-09-05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Riverside Medical Clinic Inc. | 20886 Riverside Drive, P. O. Box 1030, Grundy, Virginia 24614 |
| System for Award Management (SAM) Entities | RIVERSIDE MEDICAL CLINIC, INC. | 6405 Day St, Riverside, CA 92507-0901 |
| Street Address |
803 HWY 18 |
| City | LAKE CITY |
| State | AR |
| Zip Code | 72347-0505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003350885 | Holly Smith | Occupational Therapy Assistant | 581 Cr 115, Hickory Ridge, AR 72347-9203 | 2016-12-13 |
| 1578788253 | Ginger Elaine Wood | Speech-Language Pathologist | 262 Highway 364, Hickory Ridge, AR 72347-9248 | 2007-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669073474 | Charmaine A. Byrd | Registered Nurse | 214 Se Victoria Gln, Lake City, FL 32025-9308 | 2020-11-06 |
| 1598366171 | Neurodiverse Ability Services LLC | Counselor | 608 Sw Marvin Burnett Rd, Lake City, FL 32025-4918 | 2020-11-02 |
| 1508466889 | Eye Doctors Optical Outlets, Pa | Optometrist | 2469 W Us Highway 90 Ste A27, Lake City, FL 32055-4738 | 2020-10-27 |
| 1053910943 | Colleen Courey | Pharmacist | 1465 W Us Highway 90 Ste 110, Lake City, FL 32055-6154 | 2020-10-21 |
| 1639777345 | Concierge Home Care of Lake City LLC | Home Health | 301 Nw Cole Ter Ste 105, Lake City, FL 32055-9302 | 2020-10-14 |
| 1992303846 | Colette L Bone | Counselor | 919 Godfrey Rd, Lake City, PA 16423-2110 | 2020-10-13 |
| 1780281881 | Gateway Prescription Center Inc | Durable Medical Equipment & Medical Supplies | 742 Se Baya Dr, Lake City, FL 32025-6079 | 2020-10-02 |
| 1518564715 | Nicole Marie Hutchinson | Custodial Care Facility | 519 S Vander Meulen Rd, Lake City, MI 49651-8717 | 2020-10-01 |
| 1831796028 | Sheila Ann Breiler | Custodial Care Facility | 631 S Vander Meulen Rd, Lake City, MI 49651-9367 | 2020-10-01 |
| 1699382549 | Grace and Mercy Home Health Lc | Home Health | 2370 Green Rd, Lake City, SC 29560-5483 | 2020-09-24 |
| Find all providers in LAKE CITY | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538655766 | Silver Thread Public Health District | Family Medicine | 304 W. 3rd St, Lake City, CO 81235-0277 | 2018-07-11 |
| 1467814582 | Osayamen O Omoruyi | Family Medicine | 4784 W Us Highway 90, Lake City, FL 32055-3101 | 2016-03-28 |
| 1255698619 | Osayande Stephen Izeiyamu | Family Medicine | 194 Sw Wall Ter, Lake City, FL 32025-5086 | 2012-04-23 |
| 1508181272 | Dynamic Health Centers | Family Medicine | 163 Sw Stonegate Ter Ste 109, Lake City, FL 32024-3459 | 2010-04-06 |
| 1659506699 | Live Oak Medical Center, Pa | Family Medicine | 148 Sauls St., Lake City, SC 29560 | 2009-05-20 |
| 1871776732 | Javier D Amador | Family Medicine | 484 Sw Commerce Dr Ste 140, Lake City, FL 32025-1588 | 2007-12-13 |
| 1699838003 | Peter Wendell Giebeig Jr. | Family Medicine | 5085 West Us Hwy 90, Lake City, FL 32055 | 2006-12-18 |
| 1568544054 | Miguel Jose Tepedino | Family Medicine | 1717 Sw Newland Way, Lake City, FL 32025-6966 | 2006-10-20 |
| 1801992599 | Morris E Brown IIi | Family Medicine | 901 N. Matthews Road, Lake City, SC 29560-7024 | 2006-09-16 |
| 1235146408 | Todd A. Perla | Family Medicine | 194 Sw Wall Terrace, Origins Family Medicine and Weight Loss, Lake City, FL 32025 | 2006-08-01 |
| Find all providers in LAKE CITY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.