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NPI Code Detail

MEDICARE: RIVERSIDE PHYSICIAN SERVICES INC

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 License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1467962662
Entity Type Code : Organization
Provider Name (Legal Business Name) : RIVERSIDE PHYSICIAN SERVICES INC
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD STE A
Second Line :
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-316-5900
Fax Number : 757-534-5190
Provider Business Practice Location Address
First Line : 209 VILLAGE AVE STE P
Second Line :
City : YORKTOWN
State : VA
Zip : 23693-5639
Country : US
Telephone Number : 757-316-5050
Fax Number :
Authorized Official
Title or Position : CFO
Name : BRADEN MILLER
Credential :
Telephone Number : 757-316-5900
Provider Enumeration Date : 10/03/2017
Last Update Date : 10/03/2017

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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