Provider Demographics
NPI:1992846414
Name:SURGERY SPECIALISTS AT THE RIVER, PLLC
Entity Type:Organization
Organization Name:SURGERY SPECIALISTS AT THE RIVER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEISSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-542-4727
Mailing Address - Street 1:5287 S HIGHWAY 95 STE D
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9220
Mailing Address - Country:US
Mailing Address - Phone:928-542-4727
Mailing Address - Fax:866-504-1133
Practice Address - Street 1:5287 S HIGHWAY 95 STE D
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9220
Practice Address - Country:US
Practice Address - Phone:928-542-4727
Practice Address - Fax:866-504-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4512208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ491439Medicaid
Z113805Medicare PIN
Z169873Medicare UPIN