Provider Demographics
NPI:1194151233
Name:RIVERA, JOEY (NREMT-B)
Entity type:Individual
Prefix:
First Name:JOEY
Middle Name:
Last Name:RIVERA
Suffix:
Gender:M
Credentials:NREMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LYSTER ARMY HEALTH CLINIC
Mailing Address - Street 2:BUILDING 301 ANDREWS AVENUE
Mailing Address - City:FORT RUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:36362-5333
Mailing Address - Country:US
Mailing Address - Phone:334-255-7636
Mailing Address - Fax:334-255-7368
Practice Address - Street 1:LYSTER ARMY HEALTH CLINIC
Practice Address - Street 2:BUILDING 301 ANDREWS AVENUE
Practice Address - City:FORT RUCKER
Practice Address - State:GA
Practice Address - Zip Code:36362-5333
Practice Address - Country:US
Practice Address - Phone:334-255-7636
Practice Address - Fax:334-255-7368
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE1863404146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic