| E C Rider LLC | |
|
2815 Steven Dr Johnson City TN 37604-1936 | |
| (979) 922-9800 | |
| Not Available |
| Full Name | E C Rider LLC |
|---|---|
| Speciality | Nursing Facility/intermediate Care Facility |
| Location | 2815 Steven Dr, Johnson City, Tennessee |
| Authorized Official Name and Position | Mitchell Paul Rider (PODIATRIST) |
| Authorized Official Contact | 9799229800 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| E C Rider LLC 2815 Steven Dr Johnson City TN 37604-1936 Ph: (979) 922-9800 | E C Rider LLC 2815 Steven Dr Johnson City TN 37604-1936 Ph: (979) 922-9800 |
| NPI Number | 1164113742 |
|---|---|
| Provider Enumeration Date | 05/16/2023 |
| Last Update Date | 05/16/2023 |
| Certification Date | 05/16/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164113742 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (NU) | Secondary |
| 313M00000X | Nursing Facility/intermediate Care Facility | (NU) | Primary |
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