Provider Demographics
NPI:1124540471
Name:RIDERS CLUB OF AMERICA
Entity Type:Organization
Organization Name:RIDERS CLUB OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WISSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-365-1511
Mailing Address - Street 1:1700 B AVE NE # 213
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5421
Mailing Address - Country:US
Mailing Address - Phone:319-365-1511
Mailing Address - Fax:
Practice Address - Street 1:1700 B AVE NE # 213
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5421
Practice Address - Country:US
Practice Address - Phone:319-365-1511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle