1427775543 NPI number — RIVERSIDE HEALTHCARE PARTNERS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427775543 NPI number — RIVERSIDE HEALTHCARE PARTNERS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE HEALTHCARE PARTNERS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427775543
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
918 FLITE ACRES RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WIMBERLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78676-5437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-358-6715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 FM 2673 STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANYON LAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78133-4787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-660-3634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ARCHER
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
830-358-6715

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)