Provider Demographics
NPI:1639236102
Name:RIVERS EDGE PEDIATRICS INC
Entity Type:Organization
Organization Name:RIVERS EDGE PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-889-7772
Mailing Address - Street 1:100 N HIGH STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017
Mailing Address - Country:US
Mailing Address - Phone:614-889-7772
Mailing Address - Fax:614-764-0843
Practice Address - Street 1:100 N HIGH STREET
Practice Address - Street 2:SUITE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-889-7772
Practice Address - Fax:614-764-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059012208000000X
OH35078015208000000X
OH35081127208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty