Provider Demographics
NPI:1154491108
Name:RIVERSIDE FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:RIVERSIDE FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:AMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:612-332-1534
Mailing Address - Street 1:606 24TH AVE S
Mailing Address - Street 2:SUITE 813
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1455
Mailing Address - Country:US
Mailing Address - Phone:612-332-1534
Mailing Address - Fax:612-332-1537
Practice Address - Street 1:606 24TH AVE S
Practice Address - Street 2:SUITE 813
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1455
Practice Address - Country:US
Practice Address - Phone:612-332-1534
Practice Address - Fax:612-332-1537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1813OtherHEALTHPARTNERS
MN02962RIOtherBCBS
C00600Medicare ID - Type Unspecified
CP7196Medicare ID - Type UnspecifiedRAILROAD MEDICARE