Provider Demographics
NPI:1174615025
Name:RIA MEDICAL, LLC
Entity type:Organization
Organization Name:RIA MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-639-6262
Mailing Address - Street 1:105 CREEKSIDE OFFICE DR.
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
Mailing Address - Country:US
Mailing Address - Phone:636-639-6262
Mailing Address - Fax:636-639-1375
Practice Address - Street 1:105 CREEKSIDE OFFICE DR.
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385
Practice Address - Country:US
Practice Address - Phone:636-639-6262
Practice Address - Fax:636-639-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
MO2011002808207R00000X
MO2007036351207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204476907Medicaid
MO1437455441Medicaid
MO204488805Medicaid
MO204476907Medicaid
MOMA4981001Medicare PIN
MOMA4981007Medicare PIN
MOMA4982001Medicare PIN
MOMA4982007Medicare PIN
I69411Medicare UPIN
MO204488805Medicaid
MOMA4982002Medicare PIN
MOMA4981002Medicare PIN