Provider Demographics
NPI:1235135641
Name:RIVERSIDE PULMONARY ASSOCIATES, INC
Entity type:Organization
Organization Name:RIVERSIDE PULMONARY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:MUTCHLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-267-8585
Mailing Address - Street 1:3545 OLENTANGY RIVER RD
Mailing Address - Street 2:STE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3907
Mailing Address - Country:US
Mailing Address - Phone:614-267-8585
Mailing Address - Fax:614-267-9793
Practice Address - Street 1:3545 OLENTANGY RIVER RD
Practice Address - Street 2:STE 201
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3907
Practice Address - Country:US
Practice Address - Phone:614-267-8585
Practice Address - Fax:614-267-9793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1356010OtherUMW
OH0674462Medicaid
OH104529OtherANTHEM MEDIGAP
OH0674462Medicaid
OH=========OtherCHAMPUS VA
OH=========OtherCIGNA
OH1356010OtherUMW
OH=========-00OtherWORKERS COMPENSATION
OH=========OtherTRICARE/CHAMPUS
OH=========00OtherBC/BS