Provider Demographics
NPI:1346237831
Name:MIDDLE RIDGE INC.
Entity Type:Organization
Organization Name:MIDDLE RIDGE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTENBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-239-4300
Mailing Address - Street 1:7530 LUCERNE DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6587
Mailing Address - Country:US
Mailing Address - Phone:440-239-4300
Mailing Address - Fax:440-239-4301
Practice Address - Street 1:7530 LUCERNE DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-6587
Practice Address - Country:US
Practice Address - Phone:440-239-4300
Practice Address - Fax:440-239-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0777459Medicaid
OH0368060001Medicare ID - Type UnspecifiedPROVIDER NUMBER