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NPI Code Detail

MEDICARE: PAUL S RIDER M.D.

MEDICARE: PAUL S RIDER M.D.
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
1208000000XPediatrics Physician01023981AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1100256020OTHERINMANAGED HEALTH SERVICES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
300000082699OTHERINANTHEM
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5351265355OTHERINTAX ID

General Provider Information

NPI Number : 1659305043
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL S RIDER M.D.
Provider Business Mailing Address
First Line : 1100 REID PARKWAY
Second Line : MEDICAL STAFF SERVICES
City : RICHMOND
State : IN
Zip : 47374
Country : US
Telephone Number : 765-983-3127
Fax Number : 765-983-3219
Provider Business Practice Location Address
First Line : 1434 CHESTER BLVD
Second Line :
City : RICHMOND
State : IN
Zip : 47374-1947
Country : US
Telephone Number : 765-966-5527
Fax Number : 765-966-5527
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 03/07/2023

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Directions to “ PAUL S RIDER M.D.” Practice Location

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