1215968870 NPI number — JAMES V RIDER D.O.

Table of content: JAMES V RIDER D.O. (NPI 1215968870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215968870 NPI number — JAMES V RIDER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIDER
Provider First Name:
JAMES
Provider Middle Name:
V
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215968870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1006 ELM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY FALLS
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66088-1289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-945-6894
Provider Business Mailing Address Fax Number:
785-945-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4TH AND WINCHESTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-774-2150
Provider Business Practice Location Address Fax Number:
913-774-2308
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  05-17984 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207QG0300X , with the licence number: 2420 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2429680706 , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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