MEDICARE: RIVIERA SURGICAL CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1073107850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVIERA SURGICAL CENTER LLC

Provider Business Mailing Address
First Line	:	3003 AZ-95
Second Line	:	#63
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442
Country	:	US
Telephone Number	:	928-483-4566
Fax Number	:	928-483-4566

Provider Business Practice Location Address
First Line	:	3003 AZ-95
Second Line	:	#63
City	:	BULLHEAD CITY
State	:	AZ
Zip	:	86442
Country	:	US
Telephone Number	:	909-994-5105
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL ASSISTANT
Name	:	PAIGE HADDICK
Credential	:	MA
Telephone Number	:	928-483-4566

Provider Enumeration Date	:	02/23/2021
Last Update Date	:	12/11/2025

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