Healthcare Provider Details

I. General information

NPI: 1326375478
Provider Name (Legal Business Name): RIVERSIDE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 S CHURCH ST STE 114
SMITHFIELD VA
23430-1862
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-6333
  • Fax: 757-591-7261
Mailing address:
  • Phone: 757-594-4006
  • Fax: 757-594-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST PADDEN
Title or Position: CEO
Credential:
Phone: 757-594-4006