Provider Demographics
NPI:1437393501
Name:RIDGELINE MEDICAL LLC
Entity Type:Organization
Organization Name:RIDGELINE MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALFRED
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-620-2226
Mailing Address - Street 1:9208 WOODSTREAM LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-9559
Mailing Address - Country:US
Mailing Address - Phone:937-620-2226
Mailing Address - Fax:937-885-5101
Practice Address - Street 1:8 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1732
Practice Address - Country:US
Practice Address - Phone:513-933-9230
Practice Address - Fax:513-933-9232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies