Provider Demographics
NPI:1386470250
Name:RIVER CITY INTERNAL MEDICINE
Entity type:Organization
Organization Name:RIVER CITY INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WON
Authorized Official - Middle Name:HEE
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-707-6730
Mailing Address - Street 1:7015 BELLA MIST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-2118
Mailing Address - Country:US
Mailing Address - Phone:623-707-6730
Mailing Address - Fax:
Practice Address - Street 1:11212 STATE HIGHWAY 151 STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4498
Practice Address - Country:US
Practice Address - Phone:623-707-6730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty