Provider Demographics
NPI:1669848834
Name:RIVERSIDE SPINE & PAIN PHYSICIANS, LLC
Entity Type:Organization
Organization Name:RIVERSIDE SPINE & PAIN PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:KRAMARICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-389-1010
Mailing Address - Street 1:7207 GOLDEN WINGS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3324
Mailing Address - Country:US
Mailing Address - Phone:904-389-1010
Mailing Address - Fax:904-389-1082
Practice Address - Street 1:2386 DUNN AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-4750
Practice Address - Country:US
Practice Address - Phone:904-389-1010
Practice Address - Fax:904-389-1082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty