Healthcare Provider Details

I. General information

NPI: 1083710784
Provider Name (Legal Business Name): RIVERSIDE ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S SUITE 800
MINNEAPOLIS MN
55454-1455
US

IV. Provider business mailing address

1055 WESTGATE DR SUITE 190
SAINT PAUL MN
55114-1451
US

V. Phone/Fax

Practice location:
  • Phone: 651-225-7999
  • Fax: 651-225-7997
Mailing address:
  • Phone: 651-312-1505
  • Fax: 651-312-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number331055
License Number StateMN

VIII. Authorized Official

Name: DR. RICHARD EUGENE KARULF
Title or Position: PRESIDENT / CEO
Credential:
Phone: 651-225-7999