1740292341 NPI number — NAVDEEP RIAR MD

Table of content: NAVDEEP RIAR MD (NPI 1740292341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740292341 NPI number — NAVDEEP RIAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIAR
Provider First Name:
NAVDEEP
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1740292341
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 708850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANDY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84070-8782
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-869-2395
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1460 G ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97477-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-744-8555
Provider Business Practice Location Address Fax Number:
541-744-6150
Provider Enumeration Date:
08/12/2006

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: 207R00000X , with the licence number:  A94571 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 028544 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 838334031 . This is a "BCBS-ROSEBURG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 844477033 . This is a "BCBS-GRANTS PASS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858463031 . This is a "BCBS-MEDFORD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: P00439412 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858464035 . This is a "BCBS-SPRINGFIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: R136910 . This is a "MEDICARE-TYPE UNSPECIFIED" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 838366028 . This is a "BCBS-MCMINNVILLE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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