| River Valley Medical Group, Llc | |
|
4626 Progress Dr Ste C Davenport IA 52807-3485 | |
| (563) 551-4200 | |
| (563) 441-9101 |
| Full Name | River Valley Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4626 Progress Dr Ste C, Davenport, Iowa |
| Authorized Official Name and Position | Radhika N Kolla (PHYSICIAN/OWNER) |
| Authorized Official Contact | 5632713023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| River Valley Medical Group, Llc 4626 Progress Dr Ste C Davenport IA 52807-3485 Ph: (563) 551-4200 | River Valley Medical Group, Llc 4626 Progress Dr Ste C Davenport IA 52807-3485 Ph: (563) 551-4200 |
| NPI Number | 1396408290 |
|---|---|
| Provider Enumeration Date | 10/18/2021 |
| Last Update Date | 06/23/2023 |
| Medicare PECOS PAC ID | 4981092418 |
|---|---|
| Medicare Enrollment ID | O20211102001511 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396408290 | NPI | - | NPPES |
| G81285 | Other | MEDICARE | |
| 1598744096 | Medicaid | IA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Radhika Kolla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598744096 PECOS PAC ID: 2264483361 Enrollment ID: I20050208000483 |
| Provider Name | Marie L Mueller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699309377 PECOS PAC ID: 3072944404 Enrollment ID: I20200519000296 |
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