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General NPI Number Information
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NPI Number | 1023271459
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Entity Type | Organization
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Legal Business Name | RIVERBEND AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 07/22/2009
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Provider Practice Location Address
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Address Line | 3355 RIVERBEND DR SUITE 110
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City | SPRINGFIELD
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State | OR
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Zip | 97477-8800
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Country | US
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Telephone | 541-852-4824
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Fax | 541-242-5115
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Provider Business Mailing Address
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Address Line | 3355 RIVERBEND DR SUITE 110
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City | SPRINGFIELD
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State | OR
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Zip | 97477-8800
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Country | US
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Telephone | 541-852-4824
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Fax | 541-242-5115
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Authorized Official
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Title or Position | PRESIDENT OF BOARD OF MANAGERS
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Name | DR. ANDY KOKKINO
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Credential | MD
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Telephone | 720-320-6577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | IN PROCESS
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License Number State | OR
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