Riverside Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

153-1 Issued in MO

Legal business name

RIVERSIDE SURGERY CENTER, LLC

Practice address

6829 Parker Rd
Florissant, MO 63033-5312

Phone

(314) 373-2063

Fax

(314) 373-2070

NPI assigned

Aug 2, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Polly J Johnes, RN BSN

Title

Administrator

Phone

(314) 373-2063

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871500967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6829 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630335312",
            "telephone_number": "314-373-2063",
            "fax_number": "314-373-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6829 PARKER RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630335312",
            "telephone_number": "314-373-2063",
            "fax_number": "314-373-2070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JOHNES",
        "authorized_official_first_name": "POLLY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-373-2063",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN BSN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "153-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen De Ridgel-Langford, RN
• Mellana Riggins
• Kortney Riley
• Sharice Rivera
• Riverside Ambulatory Surgery Center, LP
• Robert F. Schwarze, P.C.
• Robert L Broady DDS PC
• Tanya Roberts
• Billie Robinson
• Debra A Robinson, PLPC

• Ambulatory Surgical Clinic/Center in Florissant, MO
• Providers in Florissant, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.