Provider Demographics
NPI:1699981886
Name:EDGAR RIOS M.D., S.C
Entity type:Organization
Organization Name:EDGAR RIOS M.D., S.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROLOGY
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-521-1100
Mailing Address - Street 1:203 MIDWEST CLUB PKWY
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2508
Mailing Address - Country:US
Mailing Address - Phone:773-521-1100
Mailing Address - Fax:773-521-9032
Practice Address - Street 1:4152 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4312
Practice Address - Country:US
Practice Address - Phone:773-521-1100
Practice Address - Fax:773-521-9032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048072261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048072Medicaid
IL0021608512OtherBLUE CROSS NUMBER
IL1881957405OtherNPI
IL0021608512OtherBLUE CROSS NUMBER
IL478250Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER