Organization
RIVERA MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA RIVERA (OFFICE MANAGER)
(618) 594-3613
Entity
Organization
Contact information
Practice address
1110 MULLIKEN ST, CARLYLE, IL 62231-1233
(618) 594-3613
(618) 594-4799
Mailing address
1110 MULLIKEN ST, CARLYLE, IL 62231-1233
(618) 594-3613
(618) 594-4799
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-096480
IL
208000000X
Pediatrics Physician
036-096480
IL
261QR1300X
Rural Health Clinic/Center
Primary
036-096480
IL
Other
Enumeration date
01/06/2011
Last updated
06/29/2012
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