Provider Demographics
NPI:1982447702
Name:RIVERBRANCH HEALTHCARE, LLC
Entity type:Organization
Organization Name:RIVERBRANCH HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:417-501-9042
Mailing Address - Street 1:566 E HARRISON ST # 235
Mailing Address - Street 2:
Mailing Address - City:REPUBLIC
Mailing Address - State:MO
Mailing Address - Zip Code:65738-1353
Mailing Address - Country:US
Mailing Address - Phone:417-501-9042
Mailing Address - Fax:949-695-4867
Practice Address - Street 1:9912 W FARM ROAD 156
Practice Address - Street 2:
Practice Address - City:REPUBLIC
Practice Address - State:MO
Practice Address - Zip Code:65738-2547
Practice Address - Country:US
Practice Address - Phone:417-501-9042
Practice Address - Fax:949-695-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care