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General NPI Number Information
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NPI Number | 1164113742
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Entity Type | Organization
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Legal Business Name | E C RIDER LLC
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Dates
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Enumeration Date | 05/16/2023
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Last Update Date | 05/16/2023
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Provider Practice Location Address
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Address Line | 2815 STEVEN DR
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City | JOHNSON CITY
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State | TN
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Zip | 37604-1936
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Country | US
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Telephone | 979-922-9800
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Fax |
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Provider Business Mailing Address
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Address Line | 2815 STEVEN DR
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City | JOHNSON CITY
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State | TN
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Zip | 37604-1936
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Country | US
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Telephone | 979-922-9800
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Fax |
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Authorized Official
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Title or Position | PODIATRIST
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Name | DR. MITCHELL PAUL RIDER
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Credential | DPM
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Telephone | 979-922-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State |
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