Surgery Center at River Road, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0110903 Issued in AZ

Legal business name

SURGERY CENTER AT RIVER ROAD, LLC

Practice address

2490 E. River Road
Suite 150
Tucson, AZ 85718-6522

Phone

(520) 382-1084

Fax

(520) 615-4572

NPI assigned

Jul 1, 2006

Organization subpart

No

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

Authorized official

Name

Gwendolyn S Maxwell, M.D.

Title

Shareholder

Phone

(520) 382-1084

Specialties & licenses 1

Addresses

Other names 1

• Aesthetic Surgery at Hacienda Del Sol Former legal business name

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411344000000",
    "number": "1801825880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2490 E. RIVER ROAD",
            "address_2": "SUITE 150",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857186522",
            "telephone_number": "520-382-1084",
            "fax_number": "520-615-4572"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 E. RIVER ROAD",
            "address_2": "SUITE 150",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857186522",
            "telephone_number": "520-382-1084",
            "fax_number": "520-615-4572"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGERY CENTER AT RIVER ROAD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2014-09-22",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "GWENDOLYN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "520-382-1084",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "0110903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aesthetic Surgery at Hacienda Del Sol",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Supported Living Systems
• Supported Living Systems
• Supported Living Systems
• Supreme Health & Transport Service LLC
• Surgcenter Tucson, LLC
• Surgical Institute of Tucson, LLC
• Surgical Wound Care Associates PLLC
• Jennifer L. Suriano, MD, MPH
• Nicole Andromeda Surran, R-DMT
• Lupe Cajero Surratt, PHARMD

• Ambulatory Surgical Clinic/Center in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; 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.