1962422998 NPI number — DR. EDUARDO JOSE RIFF M.D.

Table of content: DR. EDUARDO JOSE RIFF M.D. (NPI 1962422998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962422998 NPI number — DR. EDUARDO JOSE RIFF M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIFF
Provider First Name:
EDUARDO
Provider Middle Name:
JOSE
Provider Name Prefix Text:
DR.
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:
1962422998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-522-9730
Provider Business Mailing Address Fax Number:
865-637-2520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 W CLINCH AVE
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37916-2219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-637-8481
Provider Business Practice Location Address Fax Number:
865-637-9959
Provider Enumeration Date:
07/20/2006

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: 174400000X , with the licence number:  MD0000024782 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0214X , with the licence number: MD0000034829 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3898730 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4012380 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com