Organization
RIVERSIDE SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. POLLY J JOHNES RN BSN (ADMINISTRATOR)
(314) 373-2063
Entity
Organization
Contact information
Practice address
6829 PARKER RD, FLORISSANT, MO 63033-5312
(314) 373-2063
(314) 373-2070
Mailing address
6829 PARKER RD, FLORISSANT, MO 63033-5312
(314) 373-2063
(314) 373-2070
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
153-1
MO
Other
Enumeration date
08/02/2006
Last updated
08/22/2020
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