Provider Demographics
NPI:1659609311
Name:RIVERLAKES SURGERY CENTER LLC
Entity Type:Organization
Organization Name:RIVERLAKES SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BINGLEY
Authorized Official - Last Name:HAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-410-0010
Mailing Address - Street 1:7508 MEANY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5178
Mailing Address - Country:US
Mailing Address - Phone:661-410-0010
Mailing Address - Fax:661-589-9499
Practice Address - Street 1:7508 MEANY AVE STE B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5178
Practice Address - Country:US
Practice Address - Phone:661-410-0010
Practice Address - Fax:661-589-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical