Organization
RIVER WEST CLINIC CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J FULNER (EXECUTIVE VP LICENSURE)
(502) 253-0771
Entity
Organization
Contact information
Practice address
59335 RIVER WEST DR, SUITE B, PLAQUEMINE, LA 70764-6553
(225) 687-5594
(225) 687-5595
Mailing address
PO BOX 2121, LOWELL, AR 72745-2121
(502) 253-0771
(502) 253-0683
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
11/17/2006
Last updated
02/11/2008
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