Provider Demographics
NPI:1811187222
Name:RILEY, JOSEPH (CERTIFIED SURGICAL)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:CERTIFIED SURGICAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 WINDERSGATE CIR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-1209
Mailing Address - Country:US
Mailing Address - Phone:662-216-0563
Mailing Address - Fax:
Practice Address - Street 1:8111 WINDERSGATE CIR
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-1209
Practice Address - Country:US
Practice Address - Phone:662-216-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist