MEDICARE: RIVERSIDE MEDICAL ASSOCIATES, PLLC

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	363AM0700X	Medical Physician Assistant	100774	NC
2	207R00000X	Internal Medicine Physician	24818	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02559	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821173857
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE MEDICAL ASSOCIATES, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1348
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-1348
Country	:	US
Telephone Number	:	336-667-5296
Fax Number	:	336-667-0864

Provider Business Practice Location Address
First Line	:	702 13TH ST
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-4075
Country	:	US
Telephone Number	:	336-667-5296
Fax Number	:	336-667-0864

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	MRS. GRETA B TEMPLETON
Credential	:
Telephone Number	:	336-667-5296

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/19/2017

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