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General NPI Number Information
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NPI Number | 1346820800
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Entity Type | Organization
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Legal Business Name | RIVERSIDE MEDICAL INC
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Dates
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Enumeration Date | 04/09/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 77 CRYE LEIKE DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4055
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Country | US
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Telephone | 762-257-2100
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Fax | 762-320-5366
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Provider Business Mailing Address
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Address Line | 1019 TOWN DR
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076-9114
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Country | US
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Telephone | 859-441-8876
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GREGORY J CRAWFORD
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Credential |
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Telephone | 859-441-8876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number |
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License Number State |
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