Healthcare Provider Details

I. General information

NPI: 1053041061
Provider Name (Legal Business Name): RIVERSIDE HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 02/17/2023
Certification Date: 02/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WIMBLEDON SQ STE B
CHESAPEAKE VA
23320-4946
US

IV. Provider business mailing address

608 DENBIGH BLVD STE 800
NEWPORT NEWS VA
23608-4487
US

V. Phone/Fax

Practice location:
  • Phone: 757-277-9005
  • Fax: 757-436-2912
Mailing address:
  • Phone: 757-875-7543
  • Fax: 757-875-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WALTER W AUSTIN
Title or Position: EXEC VP, CFO
Credential:
Phone: 757-875-7545