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General NPI Number Information
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NPI Number | 1124046719
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PHYSICIAN SERVICES INC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 6750 MAIN ST STE 200
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City | GLOUCESTER
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State | VA
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Zip | 23061-5517
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Country | US
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Telephone | 804-693-2670
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Fax | 804-693-3704
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-594-4006
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Fax | 757-534-5190
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | BILLIE JO BROWN
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Credential |
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Telephone | 757-316-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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