Provider Demographics
NPI:1932167749
Name:RIVERSIDE SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:RIVERSIDE SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V P
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOSCANO
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:614-261-1900
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-261-1900
Mailing Address - Fax:614-261-7538
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 525
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-261-1900
Practice Address - Fax:614-261-7538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH680142Medicaid
9923311Medicare PIN