Provider Demographics
NPI:1053041061
Name:RIVERSIDE HOSPITAL INC
Entity Type:Organization
Organization Name:RIVERSIDE HOSPITAL INC
Other - Org Name:RIVERSIDE PHARMACY CHESAPEAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC VP, CFO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:W
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-875-7545
Mailing Address - Street 1:608 DENBIGH BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4487
Mailing Address - Country:US
Mailing Address - Phone:757-875-7543
Mailing Address - Fax:757-875-7553
Practice Address - Street 1:110 WIMBLEDON SQ STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4946
Practice Address - Country:US
Practice Address - Phone:757-277-9005
Practice Address - Fax:757-436-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy