Provider Demographics
NPI:1427216191
Name:RIVERSIDE MEDICAL INC.
Entity Type:Organization
Organization Name:RIVERSIDE MEDICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUATTERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-284-1775
Mailing Address - Street 1:401 MARKET ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2881
Mailing Address - Country:US
Mailing Address - Phone:740-284-1775
Mailing Address - Fax:740-284-1749
Practice Address - Street 1:401 MARKET ST
Practice Address - Street 2:SUITE 200
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2881
Practice Address - Country:US
Practice Address - Phone:740-282-3608
Practice Address - Fax:740-282-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D0991642291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMED369601Medicare PIN