Provider Demographics
NPI:1023228459
Name:ROCK RIDGE FAMILY MEDICINE, P.A.
Entity type:Organization
Organization Name:ROCK RIDGE FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:316-630-8200
Mailing Address - Street 1:8010 E 53RD ST N
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-8702
Mailing Address - Country:US
Mailing Address - Phone:316-630-8200
Mailing Address - Fax:316-295-4647
Practice Address - Street 1:8010 E 53RD ST N
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-8702
Practice Address - Country:US
Practice Address - Phone:316-630-8200
Practice Address - Fax:316-295-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0526012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty