Riverside Kingsley Endoscopy Surgicenter, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

RIVERSIDE KINGSLEY ENDOSCOPY SURGICENTER, LLC

Practice address

2151 Riverside Ave Ste 1
Jacksonville, FL 32204-4416

Phone

(904) 388-8686

NPI assigned

Oct 28, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

David McKnight

Title

VP/Cfo

Phone

(972) 789-2816

Specialties & licenses 1

Addresses

Other names 1

• Riverside Endoscopy Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Riverside Kingsley Endoscopy Surgicenter, LLC

  • Ambulatory Surgical Clinic/Center
  • Orange Park, FL
  • NPI 1770305104

  4183146095

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Kingsley Endoscopy Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Riverside Kingsley Endoscopy Surgicenter, LLC

  • Ambulatory Surgical Clinic/Center
  • Orange Park, FL
  • NPI 1770305104
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788998400000",
    "number": "1013739440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2151 RIVERSIDE AVE STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2151 RIVERSIDE AVE STE 1",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322044416",
            "telephone_number": "904-388-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE KINGSLEY ENDOSCOPY SURGICENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-28",
        "last_updated": "2026-09-10",
        "certification_date": "2026-09-10",
        "status": "A",
        "authorized_official_last_name": "MCKNIGHT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "972-789-2816"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Endoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marlo M Rivers, PT
• Stanley Rivers
• Riverside Anesthesia Services, LLC
• Riverside Endoscopy Center LLC
• Riverside Eye and Laser Specialists, P.a.
• Riverside Medical Diagnostic and Imaging, LLC
• Riverside Operator LLC
• Riverside Park Surgicenter LLC
• Riverside Spine & Pain Physicians, LLC
• Riverside Spine & Pain Physicians, LLC

• Ambulatory Surgical Clinic/Center in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.