Organization
RIVERSIDE MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BILL W DOUGLAS (VICE PRESIDENT AND CFO)
(815) 935-7256
Entity
Organization
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 935-7256
(815) 935-7490
Mailing address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 935-7256
(815) 935-7490
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
0002014
IL
273Y00000X
Rehabilitation Hospital Unit
0002014
IL
282N00000X
General Acute Care Hospital
Primary
0002014
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000256935X
—
GA
05
—
0029751
—
NJ
05
—
010415909
—
MO
05
—
01300193
—
KY
05
—
0132100
—
SD
05
—
01706
—
ND
05
—
0240224
—
OH
01
—
026741200
BLACK LUNG
IL
05
—
0585372
—
IA
05
—
100038960A
—
IN
05
—
100455080A
—
KS
05
—
100508766
—
NV
01
—
131841
COMPSYCH
IL
05
—
1400186
—
NC
01
—
140156B000000
SECTION 1011
IL
05
—
142381601
—
TX
05
—
159332105
—
AR
01
—
1826
RESOLVE, BLUE CROSS
IL
05
—
200012020A
—
OK
05
—
262438
—
OR
05
—
301547
—
MN
05
—
304727806
—
MI
01
—
360
BLUE CROSS
IL
01
—
366869400
DEPT OF LABOR ACS
IL
01
—
3977249
AETNA, RESOLVE ONLY
IL
05
—
404727815
—
MI
05
—
410575300
—
MN
05
—
5532100
—
SD
05
—
80489100
—
WI
05
—
807562900
—
ID
05
—
900587100
—
FL
01
—
L006923
TRICARE
IL
05
—
N193210
—
KS
05
—
RIV0186N
—
AL
Enumeration date
02/06/2007
Last updated
12/18/2009
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