Provider Demographics
NPI:1104506617
Name:THE RIDGE MEDICAL CLINIC
Entity type:Organization
Organization Name:THE RIDGE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FULL INDEPENDENT PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:MICHAELIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-317-5676
Mailing Address - Street 1:114 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72335-3327
Mailing Address - Country:US
Mailing Address - Phone:870-317-5676
Mailing Address - Fax:
Practice Address - Street 1:114 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FORREST CITY
Practice Address - State:AR
Practice Address - Zip Code:72335-3327
Practice Address - Country:US
Practice Address - Phone:870-317-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty