Provider Demographics
NPI:1275674673
Name:RIVERSIDE TRAUMA SURGEONS LLC
Entity Type:Organization
Organization Name:RIVERSIDE TRAUMA SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-261-1900
Mailing Address - Street 1:PO BOX 163
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-0163
Mailing Address - Country:US
Mailing Address - Phone:614-453-5969
Mailing Address - Fax:740-881-5609
Practice Address - Street 1:3535 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3908
Practice Address - Country:US
Practice Address - Phone:614-566-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2145557Medicaid
OH9305081Medicare PIN