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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
1207R00000XInternal Medicine PhysicianVA

General Provider Information

NPI Number : 1881847119
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 : 757-594-2195
Provider Business Practice Location Address
First Line : 2960 CHELSEA RD
Second Line :
City : WEST POINT
State : VA
Zip : 23181-9793
Country : US
Telephone Number : 804-843-4323
Fax Number :
Authorized Official
Title or Position : CREDENTIALING SPECIALIST
Name : MICHAEL J DOUCETTE
Credential :
Telephone Number : 757-594-4006
Provider Enumeration Date : 10/30/2008
Last Update Date : 10/30/2008

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Directions to “RIVERSIDE PHYSICIAN SERVICES INC ” Practice Location

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