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General NPI Number Information
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NPI Number | 1396713202
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 09/22/2008
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Provider Practice Location Address
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Address Line | 420 WILKINSON DR
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City | DYERSBURG
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State | TN
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Zip | 38024-2085
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Country | US
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Telephone | 731-285-2010
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Fax | 731-285-5600
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Provider Business Mailing Address
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Address Line | 420 WILKINSON DR
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City | DYERSBURG
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State | TN
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Zip | 38024-2085
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Country | US
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Telephone | 731-285-2010
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Fax | 731-285-5600
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Authorized Official
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Title or Position | BILLING OFFICE
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Name | SHELLEY WARREN
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Credential |
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Telephone | 731-285-2010
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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 | 0000000087
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License Number State | TN
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