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General NPI Number Information
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NPI Number | 1821332370
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Entity Type | Organization
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Legal Business Name | RIVER VALLEY ASC LLC
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Dates
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Enumeration Date | 11/22/2012
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 45 SALEM TPKE
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City | NORWICH
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State | CT
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Zip | 06360-6533
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Country | US
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Telephone | 860-859-9948
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Fax |
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Provider Business Mailing Address
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Address Line | 45 SALEM TPKE
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City | NORWICH
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State | CT
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Zip | 06360-6533
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Country | US
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Telephone | 860-859-9948
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Fax |
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | JENNIFER GALE
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Credential |
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Telephone | 860-859-9948
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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 | 0000336
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License Number State | CT
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