Provider Demographics
NPI:1710175872
Name:J GAREY RITCHIE
Entity Type:Organization
Organization Name:J GAREY RITCHIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCHIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-327-0444
Mailing Address - Street 1:904 E 20TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-4281
Mailing Address - Country:US
Mailing Address - Phone:505-327-0444
Mailing Address - Fax:505-327-0446
Practice Address - Street 1:904 E 20TH ST STE C
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4281
Practice Address - Country:US
Practice Address - Phone:505-327-0444
Practice Address - Fax:505-327-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-13
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM144213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM4238740001Medicare NSC
NM200521023Medicare PIN