Provider Demographics
NPI:1538300686
Name:RIVER CITY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:RIVER CITY MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-228-4300
Mailing Address - Street 1:7311 GREENHAVEN DR STE 145
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3595
Mailing Address - Country:US
Mailing Address - Phone:916-228-4300
Mailing Address - Fax:
Practice Address - Street 1:7311 GREENHAVEN DRIVE
Practice Address - Street 2:SUITE 145
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3589
Practice Address - Country:US
Practice Address - Phone:916-228-4300
Practice Address - Fax:916-424-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA302F00000X302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty