Provider Demographics
NPI:1962587873
Name:RIDDLE HEALTH CARE SERVICES
Entity type:Organization
Organization Name:RIDDLE HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RNWMC
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-891-3490
Mailing Address - Street 1:1068 W BALTIMORE PIKE
Mailing Address - Street 2:OUT PATIENT PAV SUITE 3303
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5104
Mailing Address - Country:US
Mailing Address - Phone:610-891-3490
Mailing Address - Fax:610-891-3493
Practice Address - Street 1:1068 W BALTIMORE PIKE
Practice Address - Street 2:OUT PATIENT PAV SUITE 3303
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5104
Practice Address - Country:US
Practice Address - Phone:610-891-3490
Practice Address - Fax:610-891-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA580177JN7Medicare PIN
PA580177Medicare UPIN