Riverside Breast Specialists LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

35-03-9979-L Issued in OH

Legal business name

RIVERSIDE BREAST SPECIALISTS LLC

Practice address

3555 Olentangy River Rd
Suite 2020
Columbus, OH 43214-3912

Phone

(614) 262-9922

Fax

(614) 262-9927

NPI assigned

Oct 25, 2007

Last updated

Oct 25, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Larry J Lilly, MDNPI 1497791180

Title

President

Phone

(614) 262-9922

Specialties & licenses 1

Addresses

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.

• Larry J Lilly, MD

  • Surgery Physician
  • Columbus, OH
  • NPI 1497791180
  NPD (past) Authorized official

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

{
    "created_epoch": "1193270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1528247665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3555 OLENTANGY RIVER RD",
            "address_2": "SUITE 2020",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143912",
            "telephone_number": "614-262-9922",
            "fax_number": "614-262-9927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3555 OLENTANGY RIVER RD",
            "address_2": "SUITE 2020",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432143912",
            "telephone_number": "614-262-9922",
            "fax_number": "614-262-9927"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE BREAST SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-25",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "LILLY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-262-9922",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "OH",
            "license": "35-03-9979-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kateeb Rivers Sr.
• Mitzi G. Rivers
• Paulena Rivers
• Robin Rivers
• Stefanie Rivers
• Riverside Critical Care Physicians, Inc
• Riverside Critical Care Physicians, Inc
• Riverside Hearing Services, Inc.
• Riverside Hearing Services, LTD (Hearing Health Solutions)
• Riverside Methodist Hospital

• Surgery Physician in Columbus, OH
• Providers in Columbus, OH by specialty
• Surgery Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.