Provider Demographics
NPI:1003146507
Name:DRY RIDGE FAMILY MEDICINE PLLC
Entity Type:Organization
Organization Name:DRY RIDGE FAMILY MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-645-7974
Mailing Address - Street 1:104 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8230
Mailing Address - Country:US
Mailing Address - Phone:828-645-7974
Mailing Address - Fax:828-645-9798
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-8230
Practice Address - Country:US
Practice Address - Phone:828-645-7974
Practice Address - Fax:828-645-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9901454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5914187Medicaid
NC2291879BMedicare PIN
NCH45563Medicare UPIN