River Region Human Services Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

RIVER REGION HUMAN SERVICES INC

Doing business as

River Region Primary Care

Practice address

3901 Carmichael Ave
Jacksonville, FL 32207-2325

Phone

(904) 899-6300

NPI assigned

Mar 3, 2021

Last updated

Mar 3, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John Distefano

Title

Clinic Consultant

Phone

(352) 317-3214

Specialties & licenses 1

Addresses

Other names 1

• River Region Primary Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1225623184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 CARMICHAEL AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072325",
            "telephone_number": "904-899-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 CARMICHAEL AVE",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322072325",
            "telephone_number": "904-899-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER REGION HUMAN SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-03",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "DISTEFANO",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CLINIC CONSULTANT",
        "authorized_official_telephone_number": "352-317-3214"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "River Region Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.