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General NPI Number Information
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NPI Number | 1154491108
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Entity Type | Organization
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Legal Business Name | RIVERSIDE FAMILY PHYSICIANS
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 606 24TH AVE S SUITE 813
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1455
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Country | US
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Telephone | 612-332-1534
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Fax | 612-332-1537
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Provider Business Mailing Address
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Address Line | 606 24TH AVE S SUITE 813
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City | MINNEAPOLIS
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State | MN
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Zip | 55454-1455
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Country | US
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Telephone | 612-332-1534
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Fax | 612-332-1537
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGORY M AMER
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Credential | MD
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Telephone | 612-332-1534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | MN
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