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 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
Primary
0002014
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
026741200
BLACK LUNG
IL
01
—
1538208210
HOSPITAL NPI
IL
01
—
360
BLUE CROSS
IL
01
—
366869400
DEPARTMENT OF LABOR
IL
01
—
L006923
TRICARE
IL
Enumeration date
01/15/2015
Last updated
01/15/2015
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