Provider Demographics
NPI:1528257532
Name:RIVERSIDE MEDICAL ASSOCIATES PC
Entity type:Organization
Organization Name:RIVERSIDE MEDICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:TSAMBASSIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-906-9473
Mailing Address - Street 1:127 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3981
Mailing Address - Country:US
Mailing Address - Phone:931-906-9473
Mailing Address - Fax:931-906-9477
Practice Address - Street 1:127 DEAN DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3981
Practice Address - Country:US
Practice Address - Phone:931-906-9473
Practice Address - Fax:931-906-9477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD-019687261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174628523OtherNPPES
TN3726341Medicare PIN