Provider Demographics
NPI:1174165237
Name:RIVER RIDGE SURGICAL SUITES, LLC
Entity type:Organization
Organization Name:RIVER RIDGE SURGICAL SUITES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ZACK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-645-4456
Mailing Address - Street 1:2031 JEFFERSONVILLE COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-8996
Mailing Address - Country:US
Mailing Address - Phone:812-360-2578
Mailing Address - Fax:
Practice Address - Street 1:2031 JEFFERSONVILLE COMMONS DR
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-8996
Practice Address - Country:US
Practice Address - Phone:812-360-2578
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-10
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical