1629180666 NPI number — RIVERVIEW PHYSICIANS, S.C.

Table of content: (NPI 1629180666)

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:
08/22/2020
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: "X" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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".




Copyright © 2007-2025 www.npivalidator.com