Healthcare Provider Details

I. General information

NPI: 1215968870
Provider Name (Legal Business Name): JAMES V RIDER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4TH AND WINCHESTER
WINCHESTER KS
66097
US

IV. Provider business mailing address

1006 ELM ST
VALLEY FALLS KS
66088-1289
US

V. Phone/Fax

Practice location:
  • Phone: 913-774-2150
  • Fax: 913-774-2308
Mailing address:
  • Phone: 785-945-6894
  • Fax: 785-945-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-17984
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number2420
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: