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General NPI Number Information
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NPI Number | 1740345057
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Entity Type | Organization
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Legal Business Name | BAYSIDE PODIATRY PA
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2009
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Provider Practice Location Address
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Address Line | 927 E COLORADO BLVD
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City | SPEARFISH
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State | SD
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Zip | 57783-2783
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Country | US
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Telephone | 605-641-5794
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Fax | 480-393-5577
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Provider Business Mailing Address
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Address Line | PO BOX 422
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City | SPEARFISH
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State | SD
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Zip | 57783-0422
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Country | US
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Telephone | 605-641-5794
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Fax | 480-393-5577
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Authorized Official
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Title or Position | OWNER
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Name | DR. LORRI RILEY
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Credential | DPM
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Telephone | 605-641-5794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PO3166
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License Number State | FL
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