Provider Demographics
NPI:1528507332
Name:RIDGE PARK URGENT CARE LLC
Entity type:Organization
Organization Name:RIDGE PARK URGENT CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-356-9729
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-356-9729
Mailing Address - Fax:
Practice Address - Street 1:16244 PEARL ROAD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-846-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care