Provider Demographics
NPI:1902912686
Name:RIORDAN CLINIC, INC
Entity type:Organization
Organization Name:RIORDAN CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER/BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUNNINGHAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-682-3100
Mailing Address - Street 1:3100 N HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3904
Mailing Address - Country:US
Mailing Address - Phone:316-682-3100
Mailing Address - Fax:316-618-8537
Practice Address - Street 1:3100 N HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3904
Practice Address - Country:US
Practice Address - Phone:316-682-3100
Practice Address - Fax:316-618-8537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0104594111N00000X
KS0430080207Q00000X
KS04320032085R0001X
KS0417711207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSCE1261Medicare ID - Type UnspecifiedOWGCHA RR - MEDICARE
KS004122Medicare ID - Type UnspecifiedOWGCHA GROUP NUMBER