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NPI Code Detail

MEDICARE: DR. SHANNON B RIDER MD

MEDICARE: DR. SHANNON B RIDER MD
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
1207R00000XInternal Medicine Physician036105880IL

Other Identifiers

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

General Provider Information

NPI Number : 1508846429
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON B RIDER MD
Provider Business Mailing Address
First Line : PO BOX 3988
Second Line :
City : CARBONDALE
State : IL
Zip : 62902-3988
Country : US
Telephone Number : 618-457-5200
Fax Number :
Provider Business Practice Location Address
First Line : 117 E CLARK ST
Second Line :
City : HARRISBURG
State : IL
Zip : 62946-2702
Country : US
Telephone Number : 618-252-8625
Fax Number : 618-351-4859
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 02/01/2021

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Directions to “ DR. SHANNON B RIDER MD” Practice Location

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