Provider Demographics
NPI:1710178710
Name:RIVER CITY NEUROLOGY PA
Entity type:Organization
Organization Name:RIVER CITY NEUROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-525-1668
Mailing Address - Street 1:8715 VILLAGE DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5405
Mailing Address - Country:US
Mailing Address - Phone:210-525-1668
Mailing Address - Fax:210-490-1931
Practice Address - Street 1:8715 VILLAGE DR
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5405
Practice Address - Country:US
Practice Address - Phone:210-490-5547
Practice Address - Fax:210-490-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z002OtherMEDICARE PTAN