NPIMap

Organization Active NPI

Riverside Ambulatory Surgery Center, LLC

Doing business as The Endoscopy & Colonoscopy Center

  • Ambulatory Surgical Clinic/Center
  • Hazelwood, MO
National Provider Identifier
1790132322
Registry record updated May 24, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
Legal business name
RIVERSIDE AMBULATORY SURGERY CENTER, LLC
Doing business as
The Endoscopy & Colonoscopy Center
Practice address
100 Village SQ
Hazelwood, MO 63042-1820
Phone
(314) 373-8931
Fax
(314) 373-8935
NPI assigned
May 24, 2016
Last updated
May 24, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2016

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

Authorized official

Name
Jenetha D Moran
Title
Officer / Authorized Official
Phone
(972) 763-3893

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X NU Primary

Addresses

Primary practice location

100 Village SQ
Hazelwood, MO 63042-1820

Mailing address

15305 Dallas Pkwy
#1600
Addison, TX 75001-4637
Phone (972) 763-3893

Other names 1

  • The Endoscopy & Colonoscopy Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Riverside Ambulatory Surgery Center LLC2 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.

NPI Registry JSON

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464048000000",
    "number": "1790132322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY",
            "address_2": "#1600",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750014637",
            "telephone_number": "972-763-3893",
            "fax_number": "972-692-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 VILLAGE SQ",
            "city": "HAZELWOOD",
            "state": "MO",
            "postal_code": "630421820",
            "telephone_number": "314-373-8931",
            "fax_number": "314-373-8935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE AMBULATORY SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2016-05-24",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JENETHA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OFFICER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "972-763-3893"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Endoscopy & Colonoscopy Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazelwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2016; 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.