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General NPI Number Information
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NPI Number | 1477922920
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SPINE & PAIN PHYSICIANS, LLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2453 US HIGHWAY 17 SUITE G
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City | RICHMOND HILL
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State | GA
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Zip | 31324-5959
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Country | US
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Telephone | 904-389-1010
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Fax | 904-389-1082
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Provider Business Mailing Address
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Address Line | 7207 GOLDEN WINGS RD SUITE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32244-3324
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Country | US
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Telephone | 904-389-1010
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Fax | 904-389-1082
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHEN SCOTT KRAMARICH
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Credential | M.D.
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Telephone | 904-389-1010
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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 |
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License Number State |
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