Provider Demographics
NPI:1811386147
Name:RIVER'S EDGE SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:RIVER'S EDGE SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-699-0303
Mailing Address - Street 1:71780 SAN JACINTO DR
Mailing Address - Street 2:BUILDING D
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5516
Mailing Address - Country:US
Mailing Address - Phone:951-699-0303
Mailing Address - Fax:
Practice Address - Street 1:71780 SAN JACINTO DR
Practice Address - Street 2:BUILDING D
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5516
Practice Address - Country:US
Practice Address - Phone:951-699-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical