Provider Demographics
NPI:1942581236
Name:RIVERSIDE AMBULATORY SURGERY CENTER, LP
Entity Type:Organization
Organization Name:RIVERSIDE AMBULATORY SURGERY CENTER, LP
Other - Org Name:UAP RIVERSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:6829 PARKER RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5312
Mailing Address - Country:US
Mailing Address - Phone:314-373-2063
Mailing Address - Fax:314-373-2070
Practice Address - Street 1:6829 PARKER RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5312
Practice Address - Country:US
Practice Address - Phone:314-373-2063
Practice Address - Fax:314-373-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty