# RIVERSIDE PHYSICIAN SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RIVERSIDE HEALTHCARE ASSOCIATES
- **Other names:** Riverside Fishing Bay Family Practice
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1053339762
- **Legal business name:** RIVERSIDE HEALTHCARE ASSOCIATES
- **Authorized official:** JAMES LEESNICK MD (VICE PRESIDENT)
- **Authorized official phone:** (757) 594-4006

## Contact information

- **Practice address:** 16681 GENERAL PULLER HWY, DELTAVILLE, VA 23043-2006
- **Practice address phone:** (804) 776-8000
- **Practice address fax:** (804) 776-6211
- **Mailing address:** 856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
- **Mailing address phone:** (757) 594-4006
- **Mailing address fax:** (757) 534-5190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 208000000X | Pediatrics Physician | — | NULL | — |
| 208000000X | Pediatrics Physician | — | — | — |

## Other

- **Enumeration date:** 07/18/2006
- **Last updated:** 10/14/2014