Basic Information
| Provider Information | |||||||||
| NPI: | 1265744460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERSIDE REGIONAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 J CLYDE MORRIS BLVD | ||||||||
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| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236011929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944737 | ||||||||
| FaxNumber: | 7575943184 | ||||||||
| Practice Location | |||||||||
| Address1: | 10510 JEFFERSON AVE STE B | ||||||||
| Address2: | |||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236013102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575944720 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2010 | ||||||||
| LastUpdateDate: | 07/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | BARNETT | ||||||||
| AuthorizedOfficialFirstName: | JEWELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR, OB/ GYN RESIDENCY | ||||||||
| AuthorizedOfficialTelephone: | 7574944413 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | 0116022247 | VA | Y | Managed Care Organizations | Health Maintenance Organization |
No ID Information.