KEVIN W RIDDLEBERGER


Address: 1551 Professional Ln, Suite 200, Longmont, CO 80501-6972
Phone: 3037721600

KEVIN W RIDDLEBERGER (NPI# 1396745683) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1396745683
Entity Type Individual
Full Name KEVIN W RIDDLEBERGER
Credential P.A.
Practice Address 1551 Professional Ln
Suite 200
Longmont
CO 80501-6972
Practice Telephone 3037721600
Practice Fax Number 3037729317
Mailing Telephone 3037721600
Mailing Fax Number 3037729317
Enumeration Date 2005-07-28
Last Update Date 2010-11-09
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant 1801 CO Physician Assistants & Advanced Practice Nursing Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
1801 CO Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
CO 54570867 05

Office Location

Street Address 1551 PROFESSIONAL LN
SUITE 200
City LONGMONT
State CO
Zip Code 80501-6972

Providers in the same location

NPI Name Taxonomy Address Enumeration
1225639008 Alan E Benson, Md, PC Specialist 1551 Professional Ln, Longmont, CO 80501-6972 2020-11-06
1821540360 Kathleen Retzke Specialist/Technologist 1551 Professional Ln, Suite 200, Longmont, CO 80501-6972 2016-11-01
1235688300 Stephanie Caroline Wilson Physician Assistant 1551 Professional Ln, Suite 220, Longmont, CO 80501-6972 2016-09-29
1629527494 Cher LLC Radiology 1551 Professional Ln, Suite 175, Longmont, CO 80501-6972 2016-09-22
1699156299 Emily Orient Harris Physical Therapist 1551 Professional Ln, Suite 145, Longmont, CO 80501-6972 2015-06-09
1508261165 Jennifer Robinson Massage Therapist 1551 Professional Ln, Suite 180, Longmont, CO 80501-6972 2014-10-24
1548663768 Kiley Stavnes Specialist/Technologist 1551 Professional Ln, Suite 200, Longmont, CO 80501-6972 2014-10-01
1861892986 William Underwood Acupuncturist 1551 Professional Ln, Suite 180, Longmont, CO 80501-6972 2014-08-26
1427479534 Dean Hocking Acupuncturist 1551 Professional Ln, Longmont, CO 80501-6972 2013-12-17
1003245861 Good Life Acupuncture & Wellness Center, LLC Clinic/Center 1551 Professional Ln, Suite 180, Longmont, CO 80501-6972 2013-11-02
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1598376774 Boulder County Public Health Public Health or Welfare 515 Coffman Street, Suite 200, Longmont, CO 80501 2020-08-12
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1861036501 Stateserv Medical of Colorado Durable Medical Equipment & Medical Supplies 63 South Pratt Pkwy, Landmont, CO 80501 2019-11-06
1558915090 Array Clinical and Therapeutic Services Assistant Behavior Analyst 451 21st Ave. Suite B, Longmont, CO 80501 2019-08-01
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1659845568 University Physicians Incorporated Advanced Practice Midwife 2030 Mountain View Ave Ste 400, Longmont, CO 80501 2019-01-14
1013404714 Crafted Physical Therapy Pllc Physical Therapist 701 Delaware Ave Unit E, Longmont, CO 80501 2018-04-18
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Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1356440382 Christie Lynn Marcotte Physician Assistant 1526 Harlequin Dr, Longmont, CO 80504-2235 2006-09-22
1316056260 St. Vrain Surgical Assists, LLC Physician Assistant 77 Baylor Dr, Longmont, CO 80503-2148 2006-08-30
1740393131 Robert Farias Physician Assistant 9539 Majestic Rd, Longmont, CO 80504-7741 2006-08-17
1770692709 Bill J Parker Physician Assistant 77 Baylor Dr, Longmont, CO 80503-2148 2006-08-30

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1033737366 Wound Solutions Inc Physician Assistant 130 Old Laramie Trl Ste 100, Lafayette, CO 80026-7014 2020-07-13
1295396513 Joseph D Timmermeyer Physician Assistant 324 Fossil Dr, Johnstown, CO 80534-7452 2019-06-26
1356805626 Heather Free Physician Assistant 3653 N Josephine St, Denver, CO 80205-3545 2019-01-30
1255804910 Jessie P Larson Physician Assistant 7847 Downing St, Denver, CO 80229-5961 2019-01-05
1710453543 Lindsay Marie Bergman Physician Assistant 1140 Edwards Village II, B-105, Edwards, CO 81632 2018-10-19
1225533136 Rafael Eduardo Castillo Physician Assistant 6200 Habitat Dr Apt 2052, Boulder, CO 80301-3235 2018-03-25
1972026276 Sophia Jane Wagner Physician Assistant 2643 Patterson Rd Ste 403, Grand Junction, CO 81506-1937 2017-07-19
1326588732 Elise Nicole Van Etten Physician Assistant 13123 E 16th Ave # 323, Anschutz Medical Campus, Aurora, CO 80045-7106 2017-03-03
1336691914 Patrick Craig Ford Physician Assistant 6500 29th St Ste 106, Greeley, CO 80634-8386 2016-10-28
1942751904 5280 Surgical Assisting Professional LLC Physician Assistant 10233 Bluffmont Dr, Lone Tree, CO 80124-5559 2016-10-14
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Competitor

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City LONGMONT
Zip Code 80501

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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