1811981145 NPI number — RIVERVIEW AMBULATORY SURGICAL CENTER LLC

Table of content: (NPI 1811981145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811981145 NPI number — RIVERVIEW AMBULATORY SURGICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW AMBULATORY SURGICAL CENTER LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811981145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
423 3RD AVE
Provider Second Line Business Mailing Address:
SUITE D
Provider Business Mailing Address City Name:
KINGSTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-331-2040
Provider Business Mailing Address Fax Number:
570-331-2043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
423 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-331-2040
Provider Business Practice Location Address Fax Number:
570-331-2043
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARNA
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
570-331-2040

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  11911500 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11911500 . This is a "DEPT OF HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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