Provider Demographics
NPI:1558759969
Name:MID-VALLEY SURGICENTER INC
Entity Type:Organization
Organization Name:MID-VALLEY SURGICENTER INC
Other - Org Name:RIVERSIDE OUTPATIENT SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARDESTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-784-4088
Mailing Address - Street 1:4500 BROCKTON AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4090
Mailing Address - Country:US
Mailing Address - Phone:951-784-4088
Mailing Address - Fax:951-784-4089
Practice Address - Street 1:4500 BROCKTON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4090
Practice Address - Country:US
Practice Address - Phone:951-784-4088
Practice Address - Fax:951-784-4089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical