Provider Demographics
NPI:1164552576
Name:WALTER J RILEY MD PC
Entity Type:Organization
Organization Name:WALTER J RILEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:515-244-9950
Mailing Address - Street 1:315 UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3128
Mailing Address - Country:US
Mailing Address - Phone:515-244-9950
Mailing Address - Fax:515-244-5933
Practice Address - Street 1:315 UNIVERSITY
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3128
Practice Address - Country:US
Practice Address - Phone:515-244-9950
Practice Address - Fax:515-244-5933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19292208600000X
GA010644208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0195636Medicaid
E06433Medicare UPIN
IA19563Medicare ID - Type Unspecified