Provider Demographics
NPI:1386003390
Name:RIVERWALK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RIVERWALK SURGERY CENTER, LLC
Other - Org Name:PRECISION SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN, GOVERNING BODY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-509-9204
Mailing Address - Street 1:4234 RIVERWALK PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-8510
Mailing Address - Country:US
Mailing Address - Phone:951-509-9204
Mailing Address - Fax:951-509-9206
Practice Address - Street 1:4234 RIVERWALK PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-8510
Practice Address - Country:US
Practice Address - Phone:951-509-9204
Practice Address - Fax:951-509-9206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical