Provider Demographics
NPI:1164930525
Name:RIVERSIDE ER LLC
Entity Type:Organization
Organization Name:RIVERSIDE ER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAEZE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWOSU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-468-5600
Mailing Address - Street 1:PO BOX 310897
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0897
Mailing Address - Country:US
Mailing Address - Phone:830-468-5600
Mailing Address - Fax:830-468-5743
Practice Address - Street 1:1860 S SEGUIN AVE
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3914
Practice Address - Country:US
Practice Address - Phone:830-468-5600
Practice Address - Fax:830-468-5743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care