Provider Demographics
NPI:1790854974
Name:RIDGEVIEW INTERNAL MEDICINE GROUP, LLP
Entity Type:Organization
Organization Name:RIDGEVIEW INTERNAL MEDICINE GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-342-3870
Mailing Address - Street 1:1850 RIDGE RD E
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2448
Mailing Address - Country:US
Mailing Address - Phone:585-342-3870
Mailing Address - Fax:585-342-7938
Practice Address - Street 1:1850 RIDGE RD E
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2448
Practice Address - Country:US
Practice Address - Phone:585-342-3870
Practice Address - Fax:585-342-7938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0569Medicare ID - Type Unspecified