Provider Demographics
NPI:1194255349
Name:RIVER NORTH PODIATRY, P. A.
Entity type:Organization
Organization Name:RIVER NORTH PODIATRY, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAME
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:501-680-5379
Mailing Address - Street 1:2411 MCCAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7505
Mailing Address - Country:US
Mailing Address - Phone:501-690-5379
Mailing Address - Fax:
Practice Address - Street 1:2411 MCCAIN BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7505
Practice Address - Country:US
Practice Address - Phone:501-680-5379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty