Provider Demographics
NPI:1811981145
Name:RIVERVIEW AMBULATORY SURGICAL CENTER LLC
Entity type:Organization
Organization Name:RIVERVIEW AMBULATORY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-331-2040
Mailing Address - Street 1:423 3RD AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-331-2040
Mailing Address - Fax:570-331-2043
Practice Address - Street 1:423 3RD AVE
Practice Address - Street 2:SUITE D
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-331-2040
Practice Address - Fax:570-331-2043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA11911500261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11911500OtherDEPT OF HEALTH
37485Medicare ID - Type Unspecified