# RIVERSIDE MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** RIVERSIDE MEDICAL CENTER
- **Other names:** Riverside Specialty Pharmacy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447963061
- **Legal business name:** RIVERSIDE MEDICAL CENTER
- **Authorized official:** PATRICIA KIM VILT (CFO)
- **Authorized official phone:** (815) 450-7754

## Contact information

- **Practice address:** 100 FITNESS DR, BOURBONNAIS, IL 60914-9584
- **Practice address phone:** (815) 634-5225
- **Practice address fax:** (779) 701-2280
- **Mailing address:** 350 N WALL ST, KANKAKEE, IL 60901-2991
- **Mailing address phone:** (815) 935-7256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 12/28/2022
- **Last updated:** 12/28/2022