Provider Demographics
NPI:1598867301
Name:RIDDLES BEAUTY SUPPLY
Entity Type:Organization
Organization Name:RIDDLES BEAUTY SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-781-8580
Mailing Address - Street 1:PO BOX 4471
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-4471
Mailing Address - Country:US
Mailing Address - Phone:417-781-8580
Mailing Address - Fax:417-781-6656
Practice Address - Street 1:1917 E 20TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1017
Practice Address - Country:US
Practice Address - Phone:417-781-8580
Practice Address - Fax:417-781-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO31433OtherBLUE CROSS BLUE SHIELD
MO=========RIDOtherMERCY HEALTH PLANS
MO=========RIDOtherMERCY HEALTH PLANS