Organization
RIVERSIDE PHYSICIAN SERVICES INC
Active
Parent organization
RIVERSIDE PHYSICIAN SERVICES INC
Other names
Long Term Acute Care Hospital
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVERSIDE PHYSICIAN SERVICES INC
Authorized official
BRADEN MILLER (CFO)
(757) 316-5906
Entity
Organization
Contact information
Practice address
12200 WARWICK BLVD STE 490A, NEWPORT NEWS, VA 23601-2548
(757) 534-9988
(757) 594-3653
Mailing address
856 J CLYDE MORRIS BLVD, SUITE A, NEWPORT NEWS, VA 23601-1318
(757) 316-5800
(757) 534-5190
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
VA
207RS0010X
Sports Medicine (Internal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
11/04/2008
Last updated
08/10/2021
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