RIVERSIDE MEDICAL CLINIC INC NPI 1508263088

NPI Information

  • NPI: 1508263088
  • Provider Name: RIVERSIDE MEDICAL CLINIC INC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 49D2089561
  • Address: 20886 RIVERSIDE DR
    GRUNDY, VA
    ZIP 24614
  • Phone: (276) 935-7515

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NPI Details

RIVERSIDE MEDICAL CLINIC INC is a family nurse practitioner in Grundy, VA. RIVERSIDE MEDICAL CLINIC INC NPI is 1508263088. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

20886 RIVERSIDE DR
GRUNDY, VA
ZIP 24614-597
Phone: (276) 935-7515
Fax: (276) 935-4351

The provider's authorized official is Tara S Williams .
The authorized official title is President and has the following contact phone number (276) 935-7515.

The CLIA number assigned to this NPI record is 49D2089561 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/26/2014 and was last updated on 1/21/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily0024168117VIRGINIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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