RIVERSIDE DERMATOLOGY & SPA LLC
NPI 1699262329
Clinic/Center - Multi-Specialty in Hannibal, MO

Active since April 18, 2018CLIA 26D1096719 · Certificate of Compliance
163 MEDICAL DR, HANNIBAL, MO 63401(573) 822-4428 Get Directions Write a Review

NPPES record last updated: April 18, 2018. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Riverside Dermatology & Spa Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

RIVERSIDE DERMATOLOGY & SPA LLC (NPI 1699262329) is a healthcare organization registered as a multi-specialty in Hannibal, Missouri and active in the NPI registry since April 2018. The organization holds a CLIA Certificate of Compliance certificate valid through January 12, 2027 and lists Linda Cooke, Owner, as its authorized official.

NPPES Registry Identity

NPI1699262329
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameRIVERSIDE DERMATOLOGY & SPA LLC
Location Address163 MEDICAL DRHannibal, MO 63401-6884
Mailing Address163 Medical DrHannibal, MO 63401-6884 · (573) 822-4428
Organization SubpartNo
Authorized OfficialLinda CookeOwner · (573) 822-3328
Enumeration DateApril 18, 2018
NPI 1699262329 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
163 MEDICAL DR, Hannibal, MO 63401

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 26D1096719

Riverside Dermatology · Hannibal, MO
Active · expires Jan 12, 2027
CLIA Number26D1096719
Laboratory TypePhysician Office
Certificate Effective DateJanuary 13, 2025
Certificate Expiration DateJanuary 12, 2027
Laboratory DirectorLinda M. Cooke
Laboratory Phone(573) 719-1818
Laboratory LocationRiverside Dermatology163 Medical Drive, Hannibal, MO 63401
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
163 MEDICAL DR
HANNIBAL, MO 63401
Nurse Practitioner
163 MEDICAL DR
HANNIBAL, MO 63401
Dermatology (MOHS-Micrographic Surgery)
163 MEDICAL DR
HANNIBAL, MO 63401
Nurse Practitioner
163 MEDICAL DR
HANNIBAL, MO 63401
Dermatology
163 MEDICAL DR
HANNIBAL, MO 63401
Dermatology
163 MEDICAL DR
HANNIBAL, MO 63401

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Riverside Dermatology & Spa LLC's NPI number?

The NPI number for Riverside Dermatology & Spa LLC is 1699262329. It was assigned to this organization in the NPPES registry on April 18, 2018.

Where is Riverside Dermatology & Spa LLC located?

Riverside Dermatology & Spa LLC is located at 163 Medical Dr, Hannibal, MO 63401. The listed phone number is (573) 822-4428.

What is Riverside Dermatology & Spa LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Riverside Dermatology & Spa LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 26D1096719) is associated with this NPI, valid through January 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Riverside Dermatology & Spa LLC accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health and Ambetter from Sunflower Health Plan and 2 other insurers list Riverside Dermatology & Spa LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Riverside Dermatology & Spa LLC was last updated on April 18, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.