Organization
RIVERTOWN WELLNESS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SIENA SHIELDS ALFORD DO (PHYSICIAN)
(843) 488-4300
Entity
Organization
Contact information
Practice address
1210 MAIN ST, CONWAY, SC 29526-3633
(843) 488-4300
(843) 488-4301
Mailing address
1210 MAIN ST, CONWAY, SC 29526-3633
(843) 488-4300
(843) 488-4301
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0285
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
42D0940858
CLIA
—
01
—
E325848035
MEDICARE ID
SC
05
—
TL0665
—
SC
Enumeration date
04/30/2015
Last updated
04/30/2015
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