Healthcare Provider Details

I. General information

NPI: 1457598542
Provider Name (Legal Business Name): RILEY AVIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 AIRPORT RD
STURGIS MI
49091-8906
US

IV. Provider business mailing address

1 AIRPORT RD
STURGIS MI
49091-8906
US

V. Phone/Fax

Practice location:
  • Phone: 269-651-2821
  • Fax: 269-651-9164
Mailing address:
  • Phone: 269-651-2821
  • Fax: 269-651-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DAVID KIM RILEY
Title or Position: PRESIDENT
Credential:
Phone: 269-651-2821