Organization
RIVERA MEDICAL OFFICE, LLC
Active
Other names
Renato B. Rivera, MD, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
LISA R RIVERA (OFFICE MANAGER)
(618) 594-3613
Entity
Organization
Contact information
Practice address
1110 MULLIKEN ST, CARLYLE, IL 62231-1233
(618) 594-3613
(681) 594-4799
Mailing address
1110 MULLIKEN ST, PO BOX 147, CARLYLE, IL 62231-1233
(618) 594-3613
(681) 594-4799
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036096480
IL
208000000X
Pediatrics Physician
036096480
IL
261QR1300X
Rural Health Clinic/Center
Primary
036-096480
IL
Other
Enumeration date
01/26/2007
Last updated
05/16/2008
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