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General NPI Number Information
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NPI Number | 1821173857
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Entity Type | Organization
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Legal Business Name | RIVERSIDE MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 05/19/2017
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Provider Practice Location Address
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Address Line | 702 13TH ST
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-4075
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Country | US
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Telephone | 336-667-5296
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Fax | 336-667-0864
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Provider Business Mailing Address
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Address Line | PO BOX 1348
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City | NORTH WILKESBORO
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State | NC
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Zip | 28659-1348
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Country | US
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Telephone | 336-667-5296
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Fax | 336-667-0864
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MRS. GRETA B TEMPLETON
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Credential |
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Telephone | 336-667-5296
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 100774
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 24818
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License Number State | NC
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