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RIVERSIDE PHYSICIAN SERVICES INC NPI 1538354279


NPI Information

NPI: 1538354279
Provider Name: RIVERSIDE PHYSICIAN SERVICES INC
Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

CLIA Number: 49D1031473

Address:
7554 HOSPITAL DR
SUITE 303
GLOUCESTER, VA
ZIP 23061
Phone: (757) 534-5340
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RIVERSIDE PHYSICIAN SERVICES INC is a vascular surgery surgery in Gloucester, VA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. RIVERSIDE PHYSICIAN SERVICES INC NPI is 1538354279. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

7554 HOSPITAL DR
SUITE 303
GLOUCESTER, VA
ZIP 23061-178
Phone: (757) 534-5340
Fax: (757) 594-3456

The provider's authorized official is Braden Miller .
The authorized official title is Cfo and has the following contact phone number (757) 316-5960.

The CLIA number assigned to this NPI record is 49D1031473 - hospital with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/6/2007 and was last updated on 9/7/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0129XSurgeryVascular SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1C03953MEDICARE PINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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