Basic Information
| Provider Information | |||||||||
| NPI: | 1104036029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYTLEWSKI | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 319 HOSPITAL DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | MARTINSVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241121928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2766344976 | ||||||||
| FaxNumber: | 2766341942 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 EAST BROADWAY | ||||||||
| Address2: | #300 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5732567700 | ||||||||
| FaxNumber: | 5732563003 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 11658A | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 11658A | WY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | 207RC0001X | 0101261684 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | BP1-0022677 | 01 | INSTITUTIONAL PERMIT | OTHER |