Healthcare Provider Details

I. General information

NPI: 1124540471
Provider Name (Legal Business Name): RIDERS CLUB OF AMERICA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 B AVE NE # 213
CEDAR RAPIDS IA
52402-5421
US

IV. Provider business mailing address

1700 B AVE NE # 213
CEDAR RAPIDS IA
52402-5421
US

V. Phone/Fax

Practice location:
  • Phone: 319-365-1511
  • Fax:
Mailing address:
  • Phone: 319-365-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MARTIN WISSENBERG
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 319-365-1511