Provider Demographics
NPI:1720448897
Name:RIVERSIDE PEDIATRICS OF DECATUR LLP
Entity Type:Organization
Organization Name:RIVERSIDE PEDIATRICS OF DECATUR LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:V
Authorized Official - Last Name:PARMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-355-1843
Mailing Address - Street 1:1304 13TH AVE SE STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4316
Mailing Address - Country:US
Mailing Address - Phone:256-355-1843
Mailing Address - Fax:256-340-2553
Practice Address - Street 1:1304 13TH AVE SE STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4316
Practice Address - Country:US
Practice Address - Phone:256-355-1843
Practice Address - Fax:256-340-2553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty