# RIVERSIDE PHYSICIAN SERVICES INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RIVERSIDE HEALTHCARE ASSOC
- **Other names:** Riverside Primary Care Kiln Creek, Riverside Primary Care KLN Creek
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1467962662
- **Legal business name:** RIVERSIDE HEALTHCARE ASSOC
- **Authorized official:** BRADEN MILLER (CFO)
- **Authorized official phone:** (757) 316-5900

## Contact information

- **Practice address:** 209 VILLAGE AVE STE P, YORKTOWN, VA 23693-5639
- **Practice address phone:** (757) 316-5050
- **Mailing address:** 856 J CLYDE MORRIS BLVD STE A, NEWPORT NEWS, VA 23601-1318
- **Mailing address phone:** (757) 316-5900
- **Mailing address fax:** (757) 534-5190

## Taxonomy

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

## Other

- **Enumeration date:** 10/03/2017
- **Last updated:** 10/03/2017