Provider Demographics
NPI:1245224799
Name:JIM RIGGINS
Entity Type:Organization
Organization Name:JIM RIGGINS
Other - Org Name:JIM'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:254-582-5363
Mailing Address - Street 1:101 JANE LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-2673
Mailing Address - Country:US
Mailing Address - Phone:254-582-5363
Mailing Address - Fax:254-582-7429
Practice Address - Street 1:101 JANE LN
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2673
Practice Address - Country:US
Practice Address - Phone:254-582-5363
Practice Address - Fax:254-582-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00218261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN140281Medicaid
TN140281Medicaid