Provider Demographics
NPI:1124206941
Name:RIVERSIDE IMAGING LLC
Entity Type:Organization
Organization Name:RIVERSIDE IMAGING LLC
Other - Org Name:COMPUTERIZED DIAGNOSTIC IMAGING CENTERS RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING ANAYLEST
Authorized Official - Prefix:
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:4000 14TH ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4083
Mailing Address - Country:US
Mailing Address - Phone:951-276-7500
Mailing Address - Fax:951-276-7543
Practice Address - Street 1:4000 14TH ST
Practice Address - Street 2:SUITE 109
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4083
Practice Address - Country:US
Practice Address - Phone:951-276-7500
Practice Address - Fax:951-276-7543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ05012ZMedicare PIN