Provider Demographics
NPI:1104888536
Name:RIVERWOOD EMERGENCY SERVICES INC.
Entity type:Organization
Organization Name:RIVERWOOD EMERGENCY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:567-368-1008
Mailing Address - Street 1:PO BOX 365
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43552-0365
Mailing Address - Country:US
Mailing Address - Phone:567-368-1008
Mailing Address - Fax:
Practice Address - Street 1:12621 ECKEL JUNCTION RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1304
Practice Address - Country:US
Practice Address - Phone:567-368-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2351360Medicaid
DA3572Medicare PIN
OH9324601Medicare PIN