=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366609836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KENNETH A, RITTER JR. M.D., APC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2008
-----------------------------------------------------
Last Update Date | 05/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2313 E MAIN ST
-----------------------------------------------------
City | NEW IBERIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70560-4091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-365-0005
-----------------------------------------------------
Fax | 337-365-0071
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2313 E MAIN ST
-----------------------------------------------------
City | NEW IBERIA
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70560-4091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-365-0005
-----------------------------------------------------
Fax | 337-365-0071
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MS. ADA C CEDEUR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-365-0005
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 59139
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------