MEDICARE: RIVERSIDE PHYSICIAN 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
1	207U00000X	Nuclear Medicine Physician	0101232846	VA
2	207RC0000X	Cardiovascular Disease Physician	0101232846	VA

General Provider Information

NPI Number	:	1427229178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD STE A
Second Line	:
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	:	117 BULIFANTS BLVD
Second Line	:	SUITE B
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5712
Country	:	US
Telephone Number	:	757-259-9540
Fax Number	:	757-259-9547

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	BILLIE JO BROWN
Credential	:
Telephone Number	:	757-316-5901

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	04/10/2026

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