Provider Demographics
NPI:1366540205
Name:RIVER CITY FAMILY PRACTICE SC
Entity type:Organization
Organization Name:RIVER CITY FAMILY PRACTICE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SPRENGELMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-747-3114
Mailing Address - Street 1:141 SINSINAWA AVE
Mailing Address - Street 2:
Mailing Address - City:EAST DUBUQUE
Mailing Address - State:IL
Mailing Address - Zip Code:61025-1218
Mailing Address - Country:US
Mailing Address - Phone:815-747-3114
Mailing Address - Fax:814-747-3131
Practice Address - Street 1:141 SINSINAWA AVE
Practice Address - Street 2:
Practice Address - City:EAST DUBUQUE
Practice Address - State:IL
Practice Address - Zip Code:61025-1218
Practice Address - Country:US
Practice Address - Phone:815-747-3114
Practice Address - Fax:814-747-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2137711Medicaid
F59732Medicare UPIN
IA2137711Medicaid