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Organization
RIVER PARK ASC LLC
Active
Organization
RIVER PARK ASC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARCI MCGRAW (CEO)
(318) 336-2225
Entity
Organization
Contact information
Practice address
107 FRONT ST, STE.1100, VIDALIA, LA 71373-2836
(318) 336-2218
Mailing address
107 FRONT ST, STE.1100, VIDALIA, LA 71373-2836
(318) 336-2218
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
128
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03027576
—
MS
05
—
1464015
—
LA
01
—
190020258Z
BLUE CROSS PROVIDER NUMBE
LA
Enumeration date
09/27/2005
Last updated
02/16/2012
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