Healthcare Provider Details

I. General information

NPI: 1962256966
Provider Name (Legal Business Name): RICHARD VIDRINE RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/16/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

IV. Provider business mailing address

1100 TUNNEL RD
ASHEVILLE NC
28805-2576
US

V. Phone/Fax

Practice location:
  • Phone: 828-298-7911
  • Fax:
Mailing address:
  • Phone: 828-791-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License Number13135
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: