Provider Demographics
NPI:1548234586
Name:JOHN RILEY IV, D.P.M., P.C.
Entity Type:Organization
Organization Name:JOHN RILEY IV, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:IV
Authorized Official - Credentials:DPM
Authorized Official - Phone:816-561-7388
Mailing Address - Street 1:411 NICHOLS RD
Mailing Address - Street 2:SUITE 174
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64112-2000
Mailing Address - Country:US
Mailing Address - Phone:816-561-7388
Mailing Address - Fax:816-561-9921
Practice Address - Street 1:411 NICHOLS RD
Practice Address - Street 2:SUITE 174
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64112-2000
Practice Address - Country:US
Practice Address - Phone:816-561-7388
Practice Address - Fax:816-561-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO615154500OtherDOL
MOCJ2991OtherRR MEDICARE
MO1548234586Medicaid
MO29539016OtherBCBSKC & PHP
KSDQ2915OtherRR MEDICARE
KSDQ2915OtherRR MEDICARE
KSK900000AMedicare PIN
MOK900000Medicare PIN