Provider Demographics
NPI:1720202286
Name:LIZABETH RILEY MD PA
Entity Type:Organization
Organization Name:LIZABETH RILEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZABETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-266-9955
Mailing Address - Street 1:7575 SAN FELIPE ST
Mailing Address - Street 2:SUITE 155
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-1711
Mailing Address - Country:US
Mailing Address - Phone:713-266-9955
Mailing Address - Fax:713-266-9956
Practice Address - Street 1:7575 SAN FELIPE ST
Practice Address - Street 2:SUITE 155
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1711
Practice Address - Country:US
Practice Address - Phone:713-266-9955
Practice Address - Fax:713-266-9956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0171207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X649Medicare PIN