Provider Demographics
NPI:1720220379
Name:RIDGE PARK URGENT CARE, LLC.
Entity Type:Organization
Organization Name:RIDGE PARK URGENT CARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-356-9844
Mailing Address - Street 1:7580 NORTHCLIFF AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BROOKLYN
Mailing Address - State:OH
Mailing Address - Zip Code:44144-3270
Mailing Address - Country:US
Mailing Address - Phone:440-886-1800
Mailing Address - Fax:216-741-5825
Practice Address - Street 1:7580 NORTHCLIFF AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3270
Practice Address - Country:US
Practice Address - Phone:440-886-1800
Practice Address - Fax:216-741-5825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-28
Last Update Date:2012-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX IDENTIFICATION NUMBER
OH9384111Medicare PIN