NPIMap

Organization Active NPI

Robert S Riddick MDPC

Doing business as Riddick Surgical Services

  • Surgery Physician
  • Vidalia, GA
National Provider Identifier
1760692388
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
054933 Issued in GA
Legal business name
ROBERT S RIDDICK MDPC
Doing business as
Riddick Surgical Services
Practice address
106 Queen Street
Suite 4
Vidalia, GA 30474
Phone
(912) 538-8545
Fax
(912) 538-8547
NPI assigned
May 23, 2007
Last updated
Dec 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Robert Steven Riddick, MDNPI 1093711871
Title
Physician Owner
Phone
(912) 538-8545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 054933 GA Primary

Addresses

Primary practice location

106 Queen Street
Suite 4
Vidalia, GA 30474

Mailing address

PO Box 1047
Vidalia, GA 30475-1047
Phone (912) 538-8545

Other identifiers 1

IdentifierTypeStateIssuer
GRP6799OtherGAMEDICARE GROUP NUMBER

Other names 1

  • Riddick Surgical Services Doing business as

National Provider Directory

National Provider Directory

Locations

247 S Main St
Ste A
Reidsville, GA 30453
Phone (912) 538-8545

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1760692388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1047",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304751047",
            "telephone_number": "912-538-8545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 QUEEN STREET",
            "address_2": "SUITE 4",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "30474",
            "telephone_number": "912-538-8545",
            "fax_number": "912-538-8547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT S RIDDICK MDPC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "RIDDICK",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "912-538-8545",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "054933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "GRP6799",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riddick Surgical Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vidalia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.