1629083449 NPI number — RILEY F UGLUM OD

Table of content: RILEY F UGLUM OD (NPI 1629083449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629083449 NPI number — RILEY F UGLUM OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UGLUM
Provider First Name:
RILEY
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
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:
1629083449
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HAMPTON
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50659-0470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-394-2326
Provider Business Mailing Address Fax Number:
641-394-2211

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 E SPRING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAMPTON
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50659-2132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-394-2326
Provider Business Practice Location Address Fax Number:
641-394-2211
Provider Enumeration Date:
07/30/2006

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: 152W00000X , with the licence number:  1631 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 18744 . This is a "MIDLANDS CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0005199 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".