Basic Information
| Provider Information | |||||||||
| NPI: | 1588761498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RIDINGS | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14607 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662165162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342133931 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14607 W 49TH ST | ||||||||
| Address2: | |||||||||
| City: | SHAWNEE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662165162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342133931 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 04/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 04-29139 | KS | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 2084N0400X | 04-29139 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 205320609 | 05 | MO | MEDICAID | 100389870A | 05 | KS | MEDICAID | 130023466 | 01 | RAILROAD MEDICARE | OTHER | 28659021 | 01 | MO | BCBS KS CITY | OTHER | 399330 | 01 | KS | FIRSTGUARD | OTHER |