Provider Demographics
NPI:1629186457
Name:RIVERVIEW OBSTETRICS AND GYNECOLOGY PLLC
Entity type:Organization
Organization Name:RIVERVIEW OBSTETRICS AND GYNECOLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERNANDEZ-MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-547-4724
Mailing Address - Street 1:5908 BEDFORD STREET
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-6605
Mailing Address - Country:US
Mailing Address - Phone:509-547-4724
Mailing Address - Fax:509-547-4881
Practice Address - Street 1:5908 BEDFORD STREET
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-6605
Practice Address - Country:US
Practice Address - Phone:509-547-4724
Practice Address - Fax:509-547-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7115173Medicaid
GAB39974Medicare Oscar/Certification
WAGAB39974Medicare PIN