Provider Demographics
NPI:1255735056
Name:RIDDLE FAMILY CARE
Entity type:Organization
Organization Name:RIDDLE FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIE
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:RIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-520-8457
Mailing Address - Street 1:315 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2603
Mailing Address - Country:US
Mailing Address - Phone:931-520-8457
Mailing Address - Fax:931-520-6373
Practice Address - Street 1:315 N WASHINGTON AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2603
Practice Address - Country:US
Practice Address - Phone:931-520-8457
Practice Address - Fax:931-520-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGMedicaid
TNPENDINGMedicare PIN