Provider Demographics
NPI:1821762329
Name:UNITED SURGERY CENTER RIVERSIDE LLC
Entity Type:Organization
Organization Name:UNITED SURGERY CENTER RIVERSIDE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-764-9396
Mailing Address - Street 1:25150 HANCOCK AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5989
Mailing Address - Country:US
Mailing Address - Phone:951-698-8805
Mailing Address - Fax:
Practice Address - Street 1:4234 RIVERWALK PKWY STE 160
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3371
Practice Address - Country:US
Practice Address - Phone:951-764-9396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical