1538208210 NPI number — RIVERSIDE MEDICAL CENTER

Table of content: (NPI 1538208210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538208210 NPI number — RIVERSIDE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538208210
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 N WALL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-935-7256
Provider Business Mailing Address Fax Number:
815-935-7490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
350 N WALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-935-7256
Provider Business Practice Location Address Fax Number:
815-935-7490
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOUGLAS
Authorized Official First Name:
BILL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
815-935-7256

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  0002014 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 273Y00000X , with the licence number: 0002014 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 0002014 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01706 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0240224 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100508766 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 262438 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 301547 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 807562900 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0029751 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0585372 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1400186 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200012020A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 404727815 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410575300 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5532100 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000256935X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304727806 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 360 . This is a "BLUE CROSS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 80489100 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: N193210 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01300193 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: RIV0186N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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