Healthcare Provider Details

I. General information

NPI: 1447487129
Provider Name (Legal Business Name): RILEY GLEE ECKMANN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2009
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 S BROADWAY ST
BLOOMFIELD NE
68718-4419
US

IV. Provider business mailing address

301 S RANDOLPH ST
BLOOMFIELD NE
68718-3134
US

V. Phone/Fax

Practice location:
  • Phone: 402-373-4341
  • Fax: 402-373-4344
Mailing address:
  • Phone: 402-490-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5978
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: