Provider Demographics
NPI:1760428338
Name:RIDGE PRIMARY CARE MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:RIDGE PRIMARY CARE MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-877-0762
Mailing Address - Street 1:6585 CLARK RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3500
Mailing Address - Country:US
Mailing Address - Phone:530-877-0762
Mailing Address - Fax:530-876-2209
Practice Address - Street 1:6585 CLARK RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3500
Practice Address - Country:US
Practice Address - Phone:530-877-0762
Practice Address - Fax:530-876-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA6834OtherMEDICARE RAILROAD #
CAH27202Medicare UPIN
DA6834OtherMEDICARE RAILROAD #