Riverside Plastic Surgery LLC

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

36140 Issued in SC

Legal business name

RIVERSIDE PLASTIC SURGERY LLC

Practice address

24 Memorial Medical Dr
Greenville, SC 29605

Phone

(864) 697-2009

Fax

(864) 697-2009

NPI assigned

Sep 3, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Brent MoisterNPI 1306042254

Title

Owner

Phone

(864) 697-2009

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Brent Moister, MD

  • Plastic and Reconstructive Surgery Physician
  • Greenville, SC
  • NPI 1306042254
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531872000000",
    "number": "1255766788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR STE 106-102",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296054452",
            "telephone_number": "864-697-2009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 MEMORIAL MEDICAL DR",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "29605",
            "telephone_number": "864-697-2009",
            "fax_number": "864-697-2009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PLASTIC SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-03",
        "last_updated": "2018-07-18",
        "status": "A",
        "authorized_official_last_name": "MOISTER",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "864-697-2009"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "SC",
            "license": "36140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Brown Rivardo, MS, CCC-SLP
• Meredith Todd Rivenbark, PA-C
• Paola Rivera
• Riverbark Inc
• Tiphany Valentine Rivers, M.A.
• Riverstone Counseling Center (Riverstone Family Counseling, LLC)
• Riverstone Family Counseling, LLC
• Christine Nabil Riyad, M.D.
• Nibal Rizk, M.D.
• Taylor Rizzetta

• Plastic and Reconstructive Surgery Physician in Greenville, SC
• Providers in Greenville, SC by specialty
• Plastic and Reconstructive Surgery Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.