Provider Demographics
NPI:1790894715
Name:RIORDAN CLINIC, INC
Entity Type:Organization
Organization Name:RIORDAN CLINIC, INC
Other - Org Name:BIO-CENTER LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER/BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUNNINGHAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-682-3100
Mailing Address - Street 1:3100 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67219-3904
Mailing Address - Country:US
Mailing Address - Phone:316-682-3100
Mailing Address - Fax:316-682-2062
Practice Address - Street 1:3100 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67219-3904
Practice Address - Country:US
Practice Address - Phone:316-682-3100
Practice Address - Fax:316-682-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS17D0648333291U00000X
KS17D0648333 (CLIA#)291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS826620026Medicare ID - Type UnspecifiedRR MEDICARE GROUP
KS008052Medicare PIN