MEDICARE: RILEY-WHITE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	P06574	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073680864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RILEY-WHITE INC

Provider Business Mailing Address
First Line	:	153 PARK SQUARE NW
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276
Country	:	US
Telephone Number	:	270-726-7626
Fax Number	:	270-726-7879

Provider Business Practice Location Address
First Line	:	153 PARK SQUARE NW
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276
Country	:	US
Telephone Number	:	270-726-7626
Fax Number	:	270-726-7879

Authorized Official
Title or Position	:	CO OWNER MANAGER
Name	:	MR. JERROLD D WHITE
Credential	:	RPH
Telephone Number	:	270-726-7626

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	02/17/2026

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Directions to “RILEY-WHITE INC ” Practice Location

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