# RIVERSTONE MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114705340
- **Authorized official:** MELISSA LUISKUTTY CCC-SLP (ADMINISTRATOR)
- **Authorized official phone:** (918) 955-9026

## Contact information

- **Practice address:** 6910 E 111TH PL S, BIXBY, OK 74008-2066
- **Practice address phone:** (918) 955-9026
- **Mailing address:** 6910 E 111TH PL S, BIXBY, OK 74008-2066
- **Mailing address phone:** (918) 955-9026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | Yes |
| 314000000X | Skilled Nursing Facility | — | NULL | — |

## Other

- **Enumeration date:** 09/19/2023
- **Last updated:** 09/19/2023