1528066578 NPI number — ANDREW RAY RIFFEY M.D.

Table of content: ANDREW RAY RIFFEY M.D. (NPI 1528066578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528066578 NPI number — ANDREW RAY RIFFEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIFFEY
Provider First Name:
ANDREW
Provider Middle Name:
RAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528066578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2006
NPI Reactivation Date:
05/01/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62906-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-833-4471
Provider Business Mailing Address Fax Number:
618-833-8878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62995-1544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-658-2811
Provider Business Practice Location Address Fax Number:
618-658-2439
Provider Enumeration Date:
07/13/2005

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:  036-112145 , 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: 080113710 . This is a "UNITED HEALTHCARE RR MEDI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: I33595 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036-112145 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108735 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 614260006 . This is a "MEDICARE PART B" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 613392200 . This is a "DOL FECA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036112145 . This is a "IDPA FEE FOR SERVICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 717084 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: I33595 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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