Organization
RIVERSTONE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA LUISKUTTY CCC-SLP (ADMINISTRATOR)
(918) 955-9026
Entity
Organization
Contact information
Practice address
6910 E 111TH PL S, BIXBY, OK 74008-2066
(918) 955-9026
Mailing address
6910 E 111TH PL S, BIXBY, OK 74008-2066
(918) 955-9026
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
—
—
314000000X
Skilled Nursing Facility
—
—
Other
Enumeration date
09/19/2023
Last updated
09/19/2023
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