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General NPI Number Information
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NPI Number | 1356311419
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Entity Type | Organization
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Legal Business Name | RIVERSIDE AMBULATORY SURGERY CENTER LLC
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 560 RIVERSIDE DRIVE #A-101
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City | SALISBURY
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State | MD
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Zip | 21801-4700
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Country | US
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Telephone | 410-749-0121
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Fax | 410-749-6807
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Provider Business Mailing Address
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Address Line | 560 RIVERSIDE DRIVE #A-101
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City | SALISBURY
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State | MD
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Zip | 21801-4700
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Country | US
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Telephone | 410-749-0121
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Fax | 410-749-6807
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. KEVIN THOMAS
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Credential | D.P.M.
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Telephone | 410-749-0121
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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 | A1077
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License Number State | MD
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