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General NPI Number Information
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NPI Number | 1851994024
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Entity Type | Organization
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Legal Business Name | RIVERCROSS DIAGNOSTICS, LLC
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 910 BROADWAY ST STE B
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City | QUINCY
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State | IL
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Zip | 62301-2729
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Country | US
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Telephone | 217-223-8400
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Fax |
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Provider Business Mailing Address
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Address Line | 910 BROADWAY ST STE B
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City | QUINCY
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State | IL
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Zip | 62301-2729
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Country | US
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Telephone | 217-223-8400
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KURT EBERS
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Credential |
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Telephone | 573-719-8933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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