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Organization
RIVERSIDE PARK SURGICENTER LLC
Active
Organization
RIVERSIDE PARK SURGICENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLIN LEMAISTRE (OFFICER/AUTHORIZED OFFICIAL)
(904) 355-9800
Entity
Organization
Contact information
Practice address
2001 COLLEGE ST, JACKSONVILLE, FL 32204-3703
(904) 355-9800
(904) 356-8680
Mailing address
2001 COLLEGE ST, JACKSONVILLE, FL 32204-3703
(904) 355-9800
(904) 356-8680
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
80003681
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
079102400
—
FL
01
—
101679
AVMED
FL
01
—
10C0001167
MEDICARE DMERC
FL
01
—
17626
CIGNA
FL
01
—
490001993
RR MEDICARE
FL
01
—
62J
BCBS
FL
01
—
6800031
UNITED
FL
Enumeration date
05/25/2005
Last updated
10/11/2024
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