Healthcare Provider Details

I. General information

NPI: 1235135641
Provider Name (Legal Business Name): RIVERSIDE PULMONARY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3907
US

IV. Provider business mailing address

3545 OLENTANGY RIVER RD STE 201
COLUMBUS OH
43214-3907
US

V. Phone/Fax

Practice location:
  • Phone: 614-267-8585
  • Fax: 614-267-9793
Mailing address:
  • Phone: 614-267-8585
  • Fax: 614-267-9793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. GAIL EUGENE MUTCHLER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-267-8585