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	208600000X	Surgery Physician		VA

General Provider Information

NPI Number	:	1871746107
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	:	757-316-5800
Fax Number	:	757-534-5190

Provider Business Practice Location Address
First Line	:	7547 MEDICAL DR STE 1200
Second Line	:
City	:	GLOUCESTER
State	:	VA
Zip	:	23061-4351
Country	:	US
Telephone Number	:	804-693-3400
Fax Number	:	804-693-9793

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

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	10/21/2025

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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