Organization
RIVERSIDE PEDIATRICS, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALI MANSOUR EBRAHIMI MD (PRESIDENT)
(660) 826-0027
Entity
Organization
Contact information
Practice address
2873 S INGRAM AVE, SEDALIA, MO 65301-8480
(660) 826-0027
(660) 826-1494
Mailing address
2873 S INGRAM AVE, SEDALIA, MO 65301-8480
(660) 826-0027
(660) 826-1494
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
101862
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101990
FIRSTGUARD INSURANCE
MO
01
—
1200288
UNITED INSURANCE
MO
01
—
187630
HEALTHLINK INSURANCE
MO
01
—
1922V3799
HEALTHCARE USA
MO
01
—
29832018
BLUE CROSS BLUE SHIELD
MO
Enumeration date
04/30/2006
Last updated
08/22/2020
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