Organization
RIVERSIDE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY WARREN (BILLING OFFICE)
(731) 285-2010
Entity
Organization
Contact information
Practice address
420 WILKINSON DR, DYERSBURG, TN 38024-2085
(731) 285-2010
(731) 285-5600
Mailing address
420 WILKINSON DR, DYERSBURG, TN 38024-2085
(731) 285-2010
(731) 285-5600
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0000000087
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3287901
—
TN
Enumeration date
03/08/2006
Last updated
09/22/2008
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