Provider Demographics
NPI:1447310420
Name:RIVER CITY GERIATRICS
Entity type:Organization
Organization Name:RIVER CITY GERIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-541-3494
Mailing Address - Street 1:6823 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1801
Mailing Address - Country:US
Mailing Address - Phone:502-541-3494
Mailing Address - Fax:502-526-4565
Practice Address - Street 1:6823 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1801
Practice Address - Country:US
Practice Address - Phone:502-541-3494
Practice Address - Fax:502-526-4565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36086207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65935512Medicaid
IN193990Medicare ID - Type Unspecified
KY7256Medicare ID - Type Unspecified