Provider Demographics
NPI:1609090927
Name:RIVERSIDE SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:RIVERSIDE SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-652-7880
Mailing Address - Street 1:501 RUE DE SANTE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAPLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5400
Mailing Address - Country:US
Mailing Address - Phone:985-652-7880
Mailing Address - Fax:985-652-7883
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAPLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-652-7880
Practice Address - Fax:985-652-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15420R208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CK95Medicare ID - Type Unspecified