# RIVER VALLEY MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1396408290
- **Authorized official:** DR. RADHIKA N KOLLA MD (PHYSICIAN/OWNER)
- **Authorized official phone:** (563) 271-3023

## Contact information

- **Practice address:** 4626 PROGRESS DR STE C, DAVENPORT, IA 52807-3485
- **Practice address phone:** (563) 551-4200
- **Practice address fax:** (563) 441-9101
- **Mailing address:** 4626 PROGRESS DR STE C, DAVENPORT, IA 52807-3485
- **Mailing address phone:** (563) 551-4200
- **Mailing address fax:** (563) 441-9101

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/18/2021
- **Last updated:** 06/23/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1598744096 | — | IA |
| 01 | — | G81285 | MEDICARE | — |