Provider Demographics
NPI:1871746453
Name:ANTHONY M RICCIARDI JR LTD INC.
Entity type:Organization
Organization Name:ANTHONY M RICCIARDI JR LTD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICCIARDI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPM
Authorized Official - Phone:702-878-2455
Mailing Address - Street 1:7135 W SAHARA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2873
Mailing Address - Country:US
Mailing Address - Phone:702-878-2455
Mailing Address - Fax:702-878-4875
Practice Address - Street 1:3175 SAINT ROSE PKWY
Practice Address - Street 2:SUITE 320
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3506
Practice Address - Country:US
Practice Address - Phone:702-878-2455
Practice Address - Fax:702-878-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9507332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5388680004Medicare NSC