Provider Demographics
NPI:1295918795
Name:RIVERSIDE MEDICAL, S.C.
Entity type:Organization
Organization Name:RIVERSIDE MEDICAL, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ESPARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-577-9300
Mailing Address - Street 1:3405 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1536
Mailing Address - Country:US
Mailing Address - Phone:847-577-9300
Mailing Address - Fax:847-577-9318
Practice Address - Street 1:3405 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1536
Practice Address - Country:US
Practice Address - Phone:847-577-9300
Practice Address - Fax:847-577-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1616210OtherBCBS GROUP
IL648500OtherMEDICAREGROUP