| Joanna Lynn Riley | |
|
2760 N Grandview Ave Suite A Odessa TX 79762-6953 | |
| (432) 552-7034 | |
| (432) 552-7165 |
| Full Name | Joanna Lynn Riley |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 2760 N Grandview Ave, Odessa, Texas |
| Authorized Official Name and Position | Joanna Riley (OWNER) |
| Authorized Official Contact | 4326384544 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Joanna Lynn Riley Po Box 14774 Odessa TX 79768-4774 Ph: (432) 638-4544 | Joanna Lynn Riley 2760 N Grandview Ave Suite A Odessa TX 79762-6953 Ph: (432) 552-7034 |
| NPI Number | 1346507209 |
|---|---|
| Provider Enumeration Date | 04/17/2012 |
| Last Update Date | 09/14/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1346507209 | NPI | - | NPPES |
| 1255617270 | Other | TX | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 109122 (Texas) | Primary |
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