Provider Demographics
NPI:1043844293
Name:S.CRIDER CONSTRUCTION AN SUPPLY CORP.
Entity type:Organization
Organization Name:S.CRIDER CONSTRUCTION AN SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:KANE
Authorized Official - Last Name:CRIDER
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:217-779-3350
Mailing Address - Street 1:529 WOODBRIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-779-3350
Mailing Address - Fax:
Practice Address - Street 1:529 WOODBRIDGE DR.
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-779-3350
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty