Riverside Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0000000087 Issued in TN

Legal business name

RIVERSIDE SURGERY CENTER, LLC

Practice address

420 Wilkinson Dr
Dyersburg, TN 38024-2085

Phone

(731) 285-2010

Fax

(731) 285-5600

NPI assigned

Mar 8, 2006

Last updated

Sep 22, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelley Warren

Title

Billing Office

Phone

(731) 285-2010

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1222041600000",
    "number": "1396713202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 WILKINSON DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242085",
            "telephone_number": "731-285-2010",
            "fax_number": "731-285-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 WILKINSON DR",
            "city": "DYERSBURG",
            "state": "TN",
            "postal_code": "380242085",
            "telephone_number": "731-285-2010",
            "fax_number": "731-285-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2008-09-22",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "BILLING OFFICE",
        "authorized_official_telephone_number": "731-285-2010"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "TN",
            "license": "0000000087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3287901",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anne Barret Richards, MSN, APRN, FNP-C
• Jane Alison Riles, DNP-C
• Courtney White Roberson, NP
• David Allen Roberts, PA-C
• Michelle Renee Roberts, FNP-BC
• Erica Nicole Robertson
• Katelyn Meredith Robertson, RN, APRN, NP-C

• Ambulatory Surgical Clinic/Center in Dyersburg, TN
• Providers in Dyersburg, TN by specialty
• Ambulatory Surgical Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.