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General NPI Number Information
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NPI Number | 1639418429
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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 | 02/14/2013
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Last Update Date | 11/18/2025
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Provider Practice Location Address
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Address Line | 1500 COMMONWEALTH AVE
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5229
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Country | US
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Telephone | 757-585-2000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 75774
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City | BALTIMORE
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State | MD
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Zip | 21275-5774
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Country | US
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Telephone | 866-898-7012
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Fax | 904-805-1037
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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