Organization
RIVERSIDE AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA BOCKOVER RN (CLINICAL DIRECTOR)
(815) 802-3170
Entity
Organization
Contact information
Practice address
300 RIVERSIDE DR STE 1100, BOURBONNAIS, IL 60914-4997
(815) 802-3170
Mailing address
300 RIVERSIDE DR STE 1100, BOURBONNAIS, IL 60914-4997
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7003049
IL
Other
Enumeration date
08/21/2006
Last updated
08/22/2020
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