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General NPI Number Information
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NPI Number | 1558642793
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH UROLOGY,LLC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 711 N 36TH ST
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City | SAINT JOSEPH
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State | MO
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Zip | 64506-2977
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Country | US
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Telephone | 816-271-8127
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Fax | 816-271-8128
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Provider Business Mailing Address
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Address Line | 711 N. 36TH ST.
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City | ST. JOSEPH
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State | MO
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Zip | 64506-2976
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Country | US
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Telephone | 816-271-8127
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Fax | 816-271-8128
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Authorized Official
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Title or Position | PROVIDER/ OWNER
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Name | JOHN F. RIORDAN
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Credential | M.D.
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Telephone | 816-271-8127
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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 | 2008011487
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License Number State | MO
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