Provider Demographics
NPI:1356481501
Name:ANTHONY M. RICCIARDI JR. LTD INC.
Entity Type:Organization
Organization Name:ANTHONY M. RICCIARDI JR. LTD INC.
Other - Org Name:FOOT ANKLE & HAND CENTER OF LAS VEGAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-878-2455
Mailing Address - Street 1:7135 W. SAHARA AVE.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2828
Mailing Address - Country:US
Mailing Address - Phone:702-878-2455
Mailing Address - Fax:702-878-4875
Practice Address - Street 1:7135 W. SAHARA AVE.
Practice Address - Street 2:SUITE 201
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2828
Practice Address - Country:US
Practice Address - Phone:702-878-2455
Practice Address - Fax:702-878-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9507213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356481501Medicaid
NV1356481501Medicaid
U56919Medicare UPIN
NV5388680002Medicare NSC
NV5388680001Medicare NSC
NVV100674Medicare PIN