1629180666 NPI number — RIVERVIEW PHYSICIANS, S.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629180666 NPI number — RIVERVIEW PHYSICIANS, S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW PHYSICIANS, S.C.
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:
1629180666
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 MEADOWVIEW CTR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KANKAKEE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60901-2047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-935-1100
Provider Business Mailing Address Fax Number:
815-937-5966

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 MEADOWVIEW CTR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
KANKAKEE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60901-2047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-935-1100
Provider Business Practice Location Address Fax Number:
815-937-5966
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
NUSRAT
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
815-935-1100

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DD6862 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04632072 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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