Provider Demographics
NPI:1780676585
Name:RIVERSIDE NEPHROLOGY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:RIVERSIDE NEPHROLOGY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-538-2250
Mailing Address - Street 1:929 JASONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2464
Mailing Address - Country:US
Mailing Address - Phone:614-538-2250
Mailing Address - Fax:614-538-2256
Practice Address - Street 1:929 JASONWAY AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2464
Practice Address - Country:US
Practice Address - Phone:614-538-2250
Practice Address - Fax:614-538-2256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-17
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0362398Medicaid
OHRI9915342Medicare ID - Type Unspecified