Organization
RIVERSIDE SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TRISH A DANIELS (ADMINISTRATOR)
(772) 589-8111
Entity
Organization
Contact information
Practice address
14410 US HIGHWAY 1, SEBASTIAN, FL 32958-3237
(772) 589-8111
(772) 589-7561
Mailing address
14410 US HIGHWAY 1, SEBASTIAN, FL 32958-3237
(772) 589-8111
(772) 589-7561
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
1034
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001577500
—
FL
01
—
0499360
GHI FACILITY NUMBER
FL
01
—
490005283
RAIL ROAD MEDICARE
FL
01
—
67R
BCBS FACILITY NUMBER
FL
01
—
F1268
MEDICARE PTAN
FL
Enumeration date
10/21/2005
Last updated
12/04/2012
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