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General NPI Number Information
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NPI Number | 1851407373
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Entity Type | Organization
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Legal Business Name | RIVERSIDE AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 08/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 300 RIVERSIDE DR STE 1100
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4997
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Country | US
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Telephone | 815-802-3170
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Fax |
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Provider Business Mailing Address
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Address Line | 300 RIVERSIDE DR STE 1100
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City | BOURBONNAIS
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State | IL
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Zip | 60914-4997
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MS. TERESA BOCKOVER
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Credential | RN
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Telephone | 815-802-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 7003049
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License Number State | IL
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