Basic Information
| Provider Information | |||||||||
| NPI: | 1083710784 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIVERSIDE ENDOSCOPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1055 WESTGATE DR | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551141451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6513121505 | ||||||||
| FaxNumber: | 6513121593 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 24TH AVE S | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554541455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512257999 | ||||||||
| FaxNumber: | 6512257997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KARULF | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | EUGENE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT / CEO | ||||||||
| AuthorizedOfficialTelephone: | 6512257999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 331055 | MN | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.