Provider Demographics
NPI:1851994024
Name:RIVERCROSS DIAGNOSTICS, LLC
Entity Type:Organization
Organization Name:RIVERCROSS DIAGNOSTICS, LLC
Other - Org Name:RIVERCROSS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-719-8933
Mailing Address - Street 1:910 BROADWAY ST STE B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-2729
Mailing Address - Country:US
Mailing Address - Phone:217-223-8400
Mailing Address - Fax:
Practice Address - Street 1:910 BROADWAY ST STE B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2729
Practice Address - Country:US
Practice Address - Phone:217-223-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-19
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory