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General NPI Number Information
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NPI Number | 1881697522
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Entity Type | Organization
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Legal Business Name | RIVERSIDE PARK SURGICENTER LLC
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Dates
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Enumeration Date | 05/25/2005
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 2001 COLLEGE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3703
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Country | US
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Telephone | 904-355-9800
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Fax | 904-356-8680
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Provider Business Mailing Address
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Address Line | 2001 COLLEGE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32204-3703
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Country | US
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Telephone | 904-355-9800
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Fax | 904-356-8680
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Authorized Official
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Title or Position | OFFICER/AUTHORIZED OFFICIAL
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Name | COLLIN LEMAISTRE
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Credential |
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Telephone | 904-355-9800
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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 | 80003681
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License Number State | FL
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