1366460305 NPI number — RIVERVIEW CANCER CENTER, INC.

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 1366460305 NPI number — RIVERVIEW CANCER CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERVIEW CANCER CENTER, INC.
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:
UW CANCER CENTER RIVERVIEW
Provider Other Organization Name Type Code:
3
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:
1366460305
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 ANGELUS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEKOOSA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54457-1617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-886-3175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 DEWEY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WISCONSIN RAPIDS
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54494
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-421-7442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERARD
Authorized Official First Name:
CELSE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
715-423-6060

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 21260300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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