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General NPI Number Information
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NPI Number | 1700876703
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Entity Type | Organization
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Legal Business Name | RIVERSIDE SURGERY CENTER INC
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 14410 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3237
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Country | US
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Telephone | 772-589-8111
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Fax | 772-589-7561
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Provider Business Mailing Address
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Address Line | 14410 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3237
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Country | US
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Telephone | 772-589-8111
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Fax | 772-589-7561
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TRISH A DANIELS
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Credential |
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Telephone | 772-589-8111
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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 | 1034
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License Number State | FL
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