Provider Demographics
NPI:1437148525
Name:CRAIG E RILEY DPM PC
Entity Type:Organization
Organization Name:CRAIG E RILEY DPM PC
Other - Org Name:COLUMBUS FOOT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:E
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-563-3668
Mailing Address - Street 1:2724 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4917
Mailing Address - Country:US
Mailing Address - Phone:402-563-3668
Mailing Address - Fax:402-563-3669
Practice Address - Street 1:2724 13TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4917
Practice Address - Country:US
Practice Address - Phone:402-563-3668
Practice Address - Fax:402-563-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE139213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2537OtherBLUE CROSS
NE=========01Medicaid
NE=========00Medicaid
NE=========00Medicaid
NE=========01Medicaid
NE0551900001Medicare NSC
NE091231Medicare PIN