MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician
2	208100000X	Physical Medicine & Rehabilitation Physician
3	2084P0800X	Psychiatry Physician
4	207QG0300X	Geriatric Medicine (Family Medicine) Physician	VA

General Provider Information

NPI Number	:	1063438943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE PHYSICIAN SERVICES INC

Provider Business Mailing Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE A
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-594-4006
Fax Number	:	754-534-5190

Provider Business Practice Location Address
First Line	:	856 J CLYDE MORRIS BLVD STE C
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	757-875-2050
Fax Number	:	757-875-2070

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	BILLIE JO BROWN
Credential	:
Telephone Number	:	757-316-5901

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	07/22/2024

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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