MEDICARE: CARLIN A RIDPATH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	105620	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	300126840	OTHER	MO	RRR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1256	OTHER	MO	BLUE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497715080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIN A RIDPATH M.D.

Provider Business Mailing Address
First Line	:	7125 E CRESCENTRIDGE DR
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3251
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7125 E CRESCENTRIDGE DR
Second Line	:
City	:	SPRINGFIELD
State	:	MO
Zip	:	65809-3251
Country	:	US
Telephone Number	:	417-496-1677
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	01/30/2024

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Directions to “ CARLIN A RIDPATH M.D.” Practice Location

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