Healthcare Provider Details

I. General information

NPI: 1831999010
Provider Name (Legal Business Name): RIVER CITY SURGICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13710 ST FRANCIS BLVD
MIDLOTHIAN VA
23114-3267
US

IV. Provider business mailing address

1021 HIOAKS RD UNIT 8855
RICHMOND VA
23225-0921
US

V. Phone/Fax

Practice location:
  • Phone: 804-999-4354
  • Fax:
Mailing address:
  • Phone: 804-999-4354
  • Fax: 804-965-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: TY SCRIVENS
Title or Position: PRESIDENT
Credential: LSA
Phone: 804-994-4354