Organization
RIVERSIDE CYTOLOGY LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC J DAUM (PRESIDENT)
(812) 548-0521
Entity
Organization
Contact information
Practice address
516 MAIN ST, SUITE B, TELL CITY, IN 47586-2211
(812) 548-0521
(812) 548-0521
Mailing address
516 MAIN ST, SUITE B, TELL CITY, IN 47586-2211
(812) 548-0521
(812) 548-0521
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
15D1022101
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000383611
BCBS NUMBER
IN
05
—
200469070A
—
IN
05
—
37000759
—
KY
Enumeration date
01/19/2007
Last updated
11/10/2011
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