MEDICARE: RIVERSIDE MEDICAL 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	332BX2000X	Oxygen Equipment & Supplies (DME)	0122	TN

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	:	1962404129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE MEDICAL INC

Provider Business Mailing Address
First Line	:	1019 TOWN DR
Second Line	:
City	:	HIGHLAND HEIGHTS
State	:	KY
Zip	:	41076-9114
Country	:	US
Telephone Number	:	859-441-8876
Fax Number	:	859-441-5850

Provider Business Practice Location Address
First Line	:	275 EUREKA ST
Second Line	:
City	:	SAVANNAH
State	:	TN
Zip	:	38372-3033
Country	:	US
Telephone Number	:	731-926-2677
Fax Number	:	731-926-2687

Authorized Official
Title or Position	:	CEO
Name	:	MR. GREGORY J CRAWFORD
Credential	:
Telephone Number	:	859-750-0018

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/15/2023

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Directions to “RIVERSIDE MEDICAL INC ” Practice Location

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