Provider Demographics
NPI:1043361850
Name:RIVERSIDE EMERGENCY MEDICAL SERVICE INC
Entity type:Organization
Organization Name:RIVERSIDE EMERGENCY MEDICAL SERVICE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-935-7378
Mailing Address - Street 1:10 HUNTER PL
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-3000
Mailing Address - Country:US
Mailing Address - Phone:937-593-9748
Mailing Address - Fax:937-599-2341
Practice Address - Street 1:105 S BOGGS
Practice Address - Street 2:
Practice Address - City:DEGRAFF
Practice Address - State:OH
Practice Address - Zip Code:43318
Practice Address - Country:US
Practice Address - Phone:937-585-5811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0637752Medicaid
OH0637752Medicaid