Provider Demographics
NPI:1811069883
Name:PATRICIA RILEY MD LTD
Entity type:Organization
Organization Name:PATRICIA RILEY MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-784-0070
Mailing Address - Street 1:5380 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1877
Mailing Address - Country:US
Mailing Address - Phone:702-784-0070
Mailing Address - Fax:702-784-0069
Practice Address - Street 1:5380 S RAINBOW BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1877
Practice Address - Country:US
Practice Address - Phone:702-784-0070
Practice Address - Fax:702-784-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF22781Medicare UPIN
NVV103231Medicare PIN