Organization
RIVERSIDE MEDICAL CENTER
Active
Parent organization
RIVERSIDE MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
RIVERSIDE MEDICAL CENTER
Authorized official
MR. BILL DOUGLAS (CFO)
(815) 935-7256
Entity
Organization
Contact information
Practice address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 933-1671
Mailing address
350 N WALL ST, KANKAKEE, IL 60901-2901
(815) 933-1671
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
980844
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04630122
BLUE SHIELD
IL
01
—
216396
PERSONAL CARE
IL
Enumeration date
12/29/2006
Last updated
04/28/2008
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