Provider Demographics
NPI:1548820194
Name:RIVERFRONT MEDICAL, LLC
Entity type:Organization
Organization Name:RIVERFRONT MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL COUNSEL
Authorized Official - Prefix:MS
Authorized Official - First Name:MORI
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:JD, LLM, CHC
Authorized Official - Phone:312-263-8600
Mailing Address - Street 1:303 W MADISON ST STE 1000
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3321
Mailing Address - Country:US
Mailing Address - Phone:312-263-8600
Mailing Address - Fax:
Practice Address - Street 1:103 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT BYRON
Practice Address - State:IL
Practice Address - Zip Code:61275-7705
Practice Address - Country:US
Practice Address - Phone:312-422-4035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty