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Organization
RIVERSIDE GYN INC
Active
Organization
RIVERSIDE GYN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARI S ANDERSON M.D. (PRESIDENT)
(513) 232-3232
Entity
Organization
Contact information
Practice address
5777 KELLOGG AVE, CINCINNATI, OH 45230-7142
(513) 232-3232
(513) 333-3024
Mailing address
5777 KELLOGG AVENUE, CINCINNATI, OH 45230
(513) 232-3232
(513) 232-3202
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
35058827
OH
173000000X
Legal Medicine
OH048288
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0605652
—
OH
05
—
2565139
—
OH
01
—
6418350001
MEDICARE DME
OH
Enumeration date
12/23/2009
Last updated
12/06/2011
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