Provider Demographics
NPI:1992769665
Name:RILEY FAMILY PRACTICE ASSOCIATES PA
Entity type:Organization
Organization Name:RILEY FAMILY PRACTICE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICALDIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:NICHOLS
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-445-2500
Mailing Address - Street 1:595 NEWBERRY HWY
Mailing Address - Street 2:PO BOX 248
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-7808
Mailing Address - Country:US
Mailing Address - Phone:864-445-2500
Mailing Address - Fax:864-445-3956
Practice Address - Street 1:595 NEWBERRY HWY
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-7808
Practice Address - Country:US
Practice Address - Phone:864-445-2500
Practice Address - Fax:864-445-3956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104970847Medicaid
SCD17899Medicare UPIN
SC423826Medicare Oscar/Certification
SC5971Medicare PIN