Provider Demographics
NPI:1184047854
Name:DRS WELCH & RIDDLE
Entity type:Organization
Organization Name:DRS WELCH & RIDDLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-621-9385
Mailing Address - Street 1:231 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489-2507
Mailing Address - Country:US
Mailing Address - Phone:860-621-9385
Mailing Address - Fax:860-276-0325
Practice Address - Street 1:231 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2507
Practice Address - Country:US
Practice Address - Phone:860-621-9385
Practice Address - Fax:860-276-0325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies