Provider Demographics
NPI:1013012764
Name:RIPLEY MEDICAL CLINIC INC
Entity Type:Organization
Organization Name:RIPLEY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCKHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-221-1637
Mailing Address - Street 1:202 TUCKER AVE
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:TN
Mailing Address - Zip Code:38063-1631
Mailing Address - Country:US
Mailing Address - Phone:731-635-4741
Mailing Address - Fax:731-635-3466
Practice Address - Street 1:202 TUCKER AVE
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063-1631
Practice Address - Country:US
Practice Address - Phone:731-635-4741
Practice Address - Fax:731-660-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732337Medicare PIN