| Rivers Edge Dpc Inc | |
|
14060 Us Highway 1 Bay Street Sebastian FL 32958-3297 | |
| (772) 202-2265 | |
| (772) 361-6362 |
| Full Name | Rivers Edge Dpc Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 14060 Us Highway 1 Bay Street, Sebastian, Florida |
| Authorized Official Name and Position | Christine Festa (OWNER) |
| Authorized Official Contact | 7722022265 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rivers Edge Dpc Inc 14060 Us Highway 1 Bay Street Sebastian FL 32958-3297 Ph: (772) 202-2265 | Rivers Edge Dpc Inc 14060 Us Highway 1 Bay Street Sebastian FL 32958-3297 Ph: (772) 202-2265 |
| NPI Number | 1538789243 |
|---|---|
| Provider Enumeration Date | 04/22/2020 |
| Last Update Date | 04/22/2020 |
| Certification Date | 04/22/2020 |
| Medicare PECOS PAC ID | 1557784824 |
|---|---|
| Medicare Enrollment ID | O20200702001971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538789243 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 363LF0000X | Nurse Practitioner - Family | () | Secondary |
| Provider Name | Christine a Festa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255803649 PECOS PAC ID: 2264762913 Enrollment ID: I20190924001848 |
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