Provider Demographics
NPI:1639342090
Name:RIVERROCK SURGICAL, PC
Entity Type:Organization
Organization Name:RIVERROCK SURGICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTANY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-625-9100
Mailing Address - Street 1:590 W RIDGE RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1094
Mailing Address - Country:US
Mailing Address - Phone:276-625-9100
Mailing Address - Fax:276-625-9101
Practice Address - Street 1:590 W RIDGE RD
Practice Address - Street 2:SUITE I
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1094
Practice Address - Country:US
Practice Address - Phone:276-625-9100
Practice Address - Fax:276-625-9101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243255208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty