Provider Demographics
NPI:1669918553
Name:EAST RIVERSIDE MEDICAL CENTER
Entity type:Organization
Organization Name:EAST RIVERSIDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE INTEGRITY ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-6709
Mailing Address - Street 1:PO BOX 840795
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0795
Mailing Address - Country:US
Mailing Address - Phone:972-899-6709
Mailing Address - Fax:
Practice Address - Street 1:2020 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-1325
Practice Address - Country:US
Practice Address - Phone:737-717-4100
Practice Address - Fax:737-717-4104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE EMERGENCY ROOM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care