Provider Demographics
NPI:1780720813
Name:RIVERSIDE FAMILY MEDICINE
Entity type:Organization
Organization Name:RIVERSIDE FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE-BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRENIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-860-0704
Mailing Address - Street 1:1210 BRIARVILLE RD
Mailing Address - Street 2:BLDG F
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5141
Mailing Address - Country:US
Mailing Address - Phone:615-860-0704
Mailing Address - Fax:615-860-9882
Practice Address - Street 1:1210 BRIARVILLE RD
Practice Address - Street 2:BLDG F
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115-5141
Practice Address - Country:US
Practice Address - Phone:615-860-0704
Practice Address - Fax:615-860-9882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3374093Medicare PIN