Healthcare Provider Details

I. General information

NPI: 1598199283
Provider Name (Legal Business Name): CRAIG E. RILEY, D.P.M., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LINCOLN AVE SUITE E
YORK NE
68467-1743
US

IV. Provider business mailing address

2724 13TH ST
COLUMBUS NE
68601-4917
US

V. Phone/Fax

Practice location:
  • Phone: 402-362-5283
  • Fax:
Mailing address:
  • Phone: 402-563-3668
  • Fax: 402-563-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number139
License Number StateNE

VIII. Authorized Official

Name: CRAIG E RILEY
Title or Position: OWNER
Credential: D.P.M.
Phone: 402-563-3668