Provider Demographics
NPI:1174178701
Name:SMR SERVICES LLC
Entity Type:Organization
Organization Name:SMR SERVICES LLC
Other - Org Name:SUSAN M MOORE-RIESBECK DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:RIESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-993-4464
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-0175
Mailing Address - Country:US
Mailing Address - Phone:574-273-8053
Mailing Address - Fax:574-273-8056
Practice Address - Street 1:28070 COUNTY ROAD 24
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-9717
Practice Address - Country:US
Practice Address - Phone:574-273-8053
Practice Address - Fax:574-273-8056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-09
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty