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Organization

JOANNA LYNN RILEY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. JOANNA RILEY LOT (OWNER)
(432) 638-4544
Entity
Organization

Contact information

Practice address
2760 N GRANDVIEW AVE, SUITE A, ODESSA, TX 79762-6953
(432) 552-7034
(432) 552-7165
Mailing address
PO BOX 14774, ODESSA, TX 79768-4774
(432) 638-4544
(432) 362-1449

Taxonomy

Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
109122
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1255617270
TYPE 1 NPI
TX
Enumeration date
04/17/2012
Last updated
09/14/2012
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