| Riverside Medical Center | |
|
350 N Wall St Kankakee IL 60901-2901 | |
| (815) 935-7256 | |
| (815) 935-7490 |
| Full Name | Riverside Medical Center |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 350 N Wall St, Kankakee, Illinois |
| Authorized Official Name and Position | Bill W Douglas (VICE PRESIDENT AND CFO) |
| Authorized Official Contact | 8159357256 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Riverside Medical Center 350 N Wall St Kankakee IL 60901-2901 Ph: (815) 935-7256 | Riverside Medical Center 350 N Wall St Kankakee IL 60901-2901 Ph: (815) 935-7256 |
| NPI Number | 1982093837 |
|---|---|
| Provider Enumeration Date | 01/15/2015 |
| Last Update Date | 01/15/2015 |
| Medicare PECOS PAC ID | 5991608549 |
|---|---|
| Medicare Enrollment ID | O20141007001332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982093837 | NPI | - | NPPES |
| 1538208210 | Other | IL | HOSPITAL NPI |
| 360 | Other | IL | BLUE CROSS |
| 026741200 | Other | IL | BLACK LUNG |
| 366869400 | Other | IL | DEPARTMENT OF LABOR |
| L006923 | Other | IL | TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | 0002014 (Illinois) | Primary |
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