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General NPI Number Information
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NPI Number | 1649509282
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Entity Type | Organization
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Legal Business Name | RIVERSIDE HOSPITAL INC
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Dates
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Enumeration Date | 12/10/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 500 J CLYDE MORRIS BLVD
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1929
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Country | US
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Telephone | 757-594-3756
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Fax | 757-594-2196
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Provider Business Mailing Address
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Address Line | 608 DENBIGH BLVD SUITE 800
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City | NEWPORT NEWS
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State | VA
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Zip | 23608-4410
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Country | US
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Telephone | 757-875-7545
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Fax | 757-875-7553
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT/CFO
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Name | WADE DUDLEY BROUGHMAN
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Credential |
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Telephone | 757-875-7543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 1293
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License Number State | VA
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