Healthcare Provider Details

I. General information

NPI: 1114227394
Provider Name (Legal Business Name): RIVERSIDE PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 WILLIAMSBURG LANDING DR
WILLIAMSBURG VA
23185-3779
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601
US

V. Phone/Fax

Practice location:
  • Phone: 757-565-6525
  • Fax: 757-565-6551
Mailing address:
  • Phone: 757-594-4006
  • Fax: 757-534-5190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: JAMES LESNICK
Title or Position: VICE PRESIDENT
Credential: MD
Phone: 757-594-4006