Provider Demographics
NPI:1770235434
Name:ON CALL ADVANTAGE
Entity Type:Organization
Organization Name:ON CALL ADVANTAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:209-768-0331
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-0456
Mailing Address - Country:US
Mailing Address - Phone:209-768-0331
Mailing Address - Fax:
Practice Address - Street 1:1026 DIAMOND HILL RD
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9795
Practice Address - Country:US
Practice Address - Phone:209-768-0331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1205342391OtherN/A