Provider Demographics
NPI:1093898702
Name:RIES, J SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:SCOTT
Last Name:RIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 7500
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620
Mailing Address - Country:US
Mailing Address - Phone:423-844-1000
Mailing Address - Fax:
Practice Address - Street 1:504 OLD JONESBORO ROAD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-844-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47774207Q00000X
VA0101250287207Q00000X
IN01049962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200268690Medicaid
IN151560BBBBMedicare PIN
IN151540AAMedicare PIN
IN200268690Medicaid
P00034469Medicare PIN
ING64101Medicare UPIN
VAV V3055AMedicare UPIN