Provider Demographics
NPI:1164113742
Name:E C RIDER LLC
Entity Type:Organization
Organization Name:E C RIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:979-922-9800
Mailing Address - Street 1:2815 STEVEN DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1936
Mailing Address - Country:US
Mailing Address - Phone:979-922-9800
Mailing Address - Fax:
Practice Address - Street 1:2815 STEVEN DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1936
Practice Address - Country:US
Practice Address - Phone:979-922-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center