Provider Demographics
NPI:1740373760
Name:RIEGER, JOSEPH A (CO, CPED)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:RIEGER
Suffix:
Gender:M
Credentials:CO, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:773 BELL RD
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-2112
Mailing Address - Country:US
Mailing Address - Phone:615-731-3338
Mailing Address - Fax:615-731-2338
Practice Address - Street 1:773 BELL RD
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-2112
Practice Address - Country:US
Practice Address - Phone:615-731-3338
Practice Address - Fax:615-731-2338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNCO004014174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3048012OtherBLUE CROSS BLUE SHIELD
KY900002072Medicaid
TN3048012OtherTENNCARE SELECT
AL009941554Medicaid
TN1454953Medicaid
165832900OtherACS - DEPT OF LABOR
KY900002072Medicaid