Healthcare Provider Details

I. General information

NPI: 1275674673
Provider Name (Legal Business Name): RIVERSIDE TRAUMA SURGEONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

PO BOX 163
HILLIARD OH
43026-0163
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5000
  • Fax:
Mailing address:
  • Phone: 614-453-5969
  • Fax: 740-881-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN D LEFF
Title or Position: PRESIDENT
Credential: MD
Phone: 614-261-1900