1023045564 NPI number — CYNTHIA K RIGGS D.B.A. WESTERN DIABETIC DELIVERY SERVICE

Table of content: (NPI 1023045564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023045564 NPI number — CYNTHIA K RIGGS D.B.A. WESTERN DIABETIC DELIVERY SERVICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIA K RIGGS D.B.A. WESTERN DIABETIC DELIVERY SERVICE
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:
1023045564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 NAVIDAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77414-2105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-244-8421
Provider Business Mailing Address Fax Number:
979-245-2132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 NAVIDAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77414-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-244-8421
Provider Business Practice Location Address Fax Number:
979-245-2132
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIGGS
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
979-244-8421

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0087004 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 90011578 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 275581 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: IDX42335 . This is a "HEALTHY U MEDICAID" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 90136811 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141809701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1189 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101580178 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 159677716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1623334 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9056912 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100816220 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: XWHJ2326 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01671724 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 554883 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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