NPIMap

Organization Active NPI

South Bend Clinic Dba Riverview Health Center

  • Family Medicine Physician
  • Raymond, WA
National Provider Identifier
1750465365
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OP00000626 Issued in WA
Legal business name
SOUTH BEND CLINIC DBA RIVERVIEW HEALTH CENTER
Practice address
300 Ocean Ave
Raymond, WA 98577-3016
Phone
(360) 942-3040
Fax
(360) 942-3955
NPI assigned
Oct 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Mrs. Rhondi R Vail-Lush
Title
Manager/Corporate Secretary
Phone
(360) 942-4562

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X OP00000626 WA Primary

Addresses

Primary practice location

300 Ocean Ave
Raymond, WA 98577-3016

Mailing address

PO Box 666
Raymond, WA 98577-0666
Phone (360) 942-3040

Other identifiers 2

IdentifierTypeStateIssuer
7840408MedicaidWA
7086515MedicaidWA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1750465365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 666",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985770666",
            "telephone_number": "360-942-3040",
            "fax_number": "360-942-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 OCEAN AVE",
            "city": "RAYMOND",
            "state": "WA",
            "postal_code": "985773016",
            "telephone_number": "360-942-3040",
            "fax_number": "360-942-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BEND CLINIC DBA RIVERVIEW HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-24",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "VAIL-LUSH",
        "authorized_official_first_name": "RHONDI",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER/CORPORATE SECRETARY",
        "authorized_official_telephone_number": "360-942-4562",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "OP00000626",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7840408",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7086515",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raymond, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; 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.