Healthcare Provider Details

I. General information

NPI: 1083107080
Provider Name (Legal Business Name): RIVERSIDE EMERGENCY PHYSICIAN PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AMBASSADOR CAFFERY PKWY BLDG 15
LAFAYETTE LA
70508-6984
US

IV. Provider business mailing address

PO BOX 721302
NORMAN OK
73070-8002
US

V. Phone/Fax

Practice location:
  • Phone: 866-783-6374
  • Fax:
Mailing address:
  • Phone: 405-240-9381
  • Fax: 405-341-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRETT MCINTYRE
Title or Position: CFO
Credential:
Phone: 850-602-0625