Provider Demographics
NPI:1366460305
Name:RIVERVIEW CANCER CENTER, INC.
Entity Type:Organization
Organization Name:RIVERVIEW CANCER CENTER, INC.
Other - Org Name:UW CANCER CENTER RIVERVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CELSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-423-6060
Mailing Address - Street 1:1015 ANGELUS DR
Mailing Address - Street 2:
Mailing Address - City:NEKOOSA
Mailing Address - State:WI
Mailing Address - Zip Code:54457-1617
Mailing Address - Country:US
Mailing Address - Phone:715-886-3175
Mailing Address - Fax:
Practice Address - Street 1:410 DEWEY STREET
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494
Practice Address - Country:US
Practice Address - Phone:715-421-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21260300Medicaid
WI72005Medicare ID - Type Unspecified