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Organization
RIVERSIDE AMBULATORY SURGERY CENTER, LLC
Active
Organization
RIVERSIDE AMBULATORY SURGERY CENTER, LLC
Active
Other names
The Endoscopy & Colonoscopy Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER HARTSHORN (MEDICARE AUTHORIZED OFFICIAL)
(314) 800-2017
Entity
Organization
Contact information
Practice address
100 VILLAGE SQ, HAZELWOOD, MO 63042-1820
(314) 373-8931
(314) 373-8935
Mailing address
100 VILLAGE SQ, HAZELWOOD, MO 63042-1820
(314) 373-8931
(314) 373-8935
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192544
BLUE CROSS BLUE SHIELD
MO
05
—
504453606
—
MO
01
—
P00240669
RAILROAD MEDICARE
MO
Enumeration date
11/16/2006
Last updated
09/06/2024
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