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General NPI Number Information
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NPI Number | 1972539039
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Entity Type | Organization
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Legal Business Name | RIVERSIDE EMERGENCY PHYSICIANS MEDICAL GROUP
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3865 JACKSON ST
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City | RIVERSIDE
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State | CA
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Zip | 92503-3919
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Country | US
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Telephone | 951-898-0823
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Fax | 951-352-5445
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Provider Business Mailing Address
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Address Line | 4401 W MEMORIAL RD SUITE 121
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City | OKLAHOMA CITY
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State | OK
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Zip | 73134-1785
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Country | US
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Telephone | 800-749-4560
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Fax | 405-755-5283
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | CHAD L. CLARK
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Credential | M.D.
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Telephone | 626-447-0296
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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 | CA
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