1316051741 NPI number — RIVERSIDE ORTHOPEDICS, LTD

Table of content: (NPI 1316051741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316051741 NPI number — RIVERSIDE ORTHOPEDICS, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERSIDE ORTHOPEDICS, LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316051741
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6641 WEST OGDEN AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERWYN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60402-3756
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-484-9480
Provider Business Mailing Address Fax Number:
708-484-9482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6641 WEST OGDEN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWYN
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60402-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-484-9480
Provider Business Practice Location Address Fax Number:
708-484-9482
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
IFTIKHAR
Authorized Official First Name:
TARIQ
Authorized Official Middle Name:
BIN
Authorized Official Title or Position:
ORTHOPEDIC SURGEON
Authorized Official Telephone Number:
708-484-9480

Provider Taxonomy Codes

  • Taxonomy code: 207XS0106X , with the licence number:  036047917 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3181386 . This is a "AETNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036047917 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006895400 . This is a "FEDERAL BLACK LUNG PROGRA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 154664 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 202841400 . This is a "ACS/OWCP" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 320541514 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00064487 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 01633335 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 2072539 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: AS62001780001 . This is a "CIGNA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 1343149 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com