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NPI Code Detail

MEDICARE: RIVERSIDE PHYSCIAN SERVICES INC

MEDICARE: RIVERSIDE PHYSCIAN SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician

General Provider Information

NPI Number : 1124044599
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE PHYSCIAN SERVICES INC
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-594-4006
Fax Number : 757-534-5190
Provider Business Practice Location Address
First Line : 2855 DENBIGH BLVD
Second Line :
City : GRAFTON
State : VA
Zip : 23692-6501
Country : US
Telephone Number : 757-750-2200
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : BILLIE JO BROWN
Credential :
Telephone Number : 757-316-5901
Provider Enumeration Date : 07/15/2006
Last Update Date : 08/22/2023

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Directions to “RIVERSIDE PHYSCIAN SERVICES INC ” Practice Location

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