Provider Demographics
NPI:1215137567
Name:RICKEY WRIGHT MD LLC
Entity type:Organization
Organization Name:RICKEY WRIGHT MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-334-7737
Mailing Address - Street 1:1907 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-1637
Mailing Address - Country:US
Mailing Address - Phone:419-334-7737
Mailing Address - Fax:419-334-2528
Practice Address - Street 1:1823 W STATE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1635
Practice Address - Country:US
Practice Address - Phone:419-334-7737
Practice Address - Fax:419-334-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058763208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000484130OtherANTHEM BCBS
420846233-007OtherMEDICAL MUTUAL OF OHIO
OH2051014Medicaid
OH420846233-00OtherWORKERS COMPENSATION
OH420846233-00OtherWORKERS COMPENSATION
420846233-007OtherMEDICAL MUTUAL OF OHIO