Provider Demographics
NPI:1356569610
Name:LOUIS-RICCIARDI ETAL PTR
Entity type:Organization
Organization Name:LOUIS-RICCIARDI ETAL PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-367-7734
Mailing Address - Street 1:508 MEDICAL CENTER BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2808
Mailing Address - Country:US
Mailing Address - Phone:936-756-8222
Mailing Address - Fax:936-756-3472
Practice Address - Street 1:508 MEDICAL CENTER BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2808
Practice Address - Country:US
Practice Address - Phone:936-756-8222
Practice Address - Fax:936-756-3472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1084710002Medicare NSC