Organization
RIVERSIDE AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN THOMAS D.P.M. (MEDICAL DIRECTOR)
(410) 749-0121
Entity
Organization
Contact information
Practice address
560 RIVERSIDE DRIVE, #A-101, SALISBURY, MD 21801-4700
(410) 749-0121
(410) 749-6807
Mailing address
560 RIVERSIDE DRIVE, #A-101, SALISBURY, MD 21801-4700
(410) 749-0121
(410) 749-6807
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
A1077
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023T
CAREFIRST
MD
01
—
320088
UNITED HEALTHCARE
MD
01
—
NN1
BLUE SHEILD
DC
05
—
T78068100
—
MD
Enumeration date
01/23/2006
Last updated
03/20/2015
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