MEDICARE: RIVERSIDE TAPPAHANNOCK HOSPITAL INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	497025B	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235134123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE TAPPAHANNOCK HOSPITAL INC

Provider Business Mailing Address
First Line	:	PO BOX 120014
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23612-0014
Country	:	US
Telephone Number	:	757-594-4600
Fax Number	:	757-594-3386

Provider Business Practice Location Address
First Line	:	856 J CLYDE MORRIS BLVD
Second Line	:	SUITE C
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23601-1318
Country	:	US
Telephone Number	:	804-443-6276
Fax Number	:	804-443-6275

Authorized Official
Title or Position	:	DIRECTOR OF HOME HEALTH
Name	:	MRS. VICKIE MORGAN
Credential	:	RN
Telephone Number	:	757-594-4600

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	08/01/2007

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