Provider Demographics
NPI:1396883807
Name:RIVERLAND MEDICAL CENTERS, INC
Entity type:Organization
Organization Name:RIVERLAND MEDICAL CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LUNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-612-0293
Mailing Address - Street 1:2774 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-2927
Mailing Address - Country:US
Mailing Address - Phone:954-791-5184
Mailing Address - Fax:954-791-3458
Practice Address - Street 1:2774 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2927
Practice Address - Country:US
Practice Address - Phone:954-791-5184
Practice Address - Fax:954-791-3458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377055900Medicaid