Provider Demographics
NPI:1174780613
Name:RIVERSIDE MEDICAL CENTER
Entity type:Organization
Organization Name:RIVERSIDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-542-2456
Mailing Address - Street 1:636 NORTHLAND BLVD
Mailing Address - Street 2:STE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3221
Mailing Address - Country:US
Mailing Address - Phone:513-542-2456
Mailing Address - Fax:513-542-3139
Practice Address - Street 1:3609 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076-2029
Practice Address - Country:US
Practice Address - Phone:513-542-2456
Practice Address - Fax:513-542-3139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04979738261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65906976Medicaid
KY64345002Medicaid