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General NPI Number Information
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NPI Number | 1093884439
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Entity Type | Organization
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Legal Business Name | RIVERSIDE MEDICAL CENTER, PA
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 863 N COCOA BLVD
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City | COCOA
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State | FL
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Zip | 32922-7510
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Country | US
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Telephone | 321-264-2345
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Fax | 321-735-8882
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Provider Business Mailing Address
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Address Line | 3206 S HOPKINS AVE SUITE 87
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City | TITUSVILLE
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State | FL
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Zip | 32780-5667
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Country | US
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Telephone | 321-264-2345
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Fax | 321-735-8882
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JANET E MILEY
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Credential | MD
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Telephone | 321-264-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 207RC0200X
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License Number State | FL
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