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Riverside Pediatrics, INC

Clinic/Center, Primary Care in Sedalia, MO. Organization (NPI-2).

NPI number1790742971
StatusActive
Last updated in NPPESAug 22, 2020

Details

NPI
1790742971
Entity type
Organization (NPI-2)
Legal business name
Riverside Pediatrics, INC
Organization subpart
No
Enumeration date
Apr 30, 2006
Last updated
Aug 22, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2300X Clinic/Center, Primary Care101862MOYes

Practice location

2873 S Ingram Ave
Sedalia, MO 65301-8480

Phone 660-826-0027 · Fax 660-826-1494

Mailing address

2873 S Ingram Ave
Sedalia, MO 65301-8480

Phone 660-826-0027 · Fax 660-826-1494

Authorized official

Ali Mansour Ebrahimi
President
6608260027

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