Provider Demographics
NPI:1588839609
Name:RIVERWALK AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:RIVERWALK AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:941-782-5439
Mailing Address - Street 1:200 3RD AVE W STE 170
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8632
Mailing Address - Country:US
Mailing Address - Phone:941-782-5439
Mailing Address - Fax:941-782-5438
Practice Address - Street 1:200 3RD AVE W., STE 170
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8632
Practice Address - Country:US
Practice Address - Phone:941-782-5434
Practice Address - Fax:941-782-5438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QA1903X
FL1304261QA1903X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11918800Medicaid