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NPI Code Detail

MEDICARE: DR. PRINTELLA RIDGEWAY M.D.

MEDICARE: DR. PRINTELLA RIDGEWAY M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician11329AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2510-65891OTHERALBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5051032503OTHERALBLUE SHIELD

General Provider Information

NPI Number : 1144282856
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PRINTELLA RIDGEWAY M.D.
Provider Business Mailing Address
First Line : 601 WEST BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35206-1300
Country : US
Telephone Number : 205-591-5180
Fax Number : 205-510-3476
Provider Business Practice Location Address
First Line : 601 WEST BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35206-1300
Country : US
Telephone Number : 205-591-5180
Fax Number : 205-510-3476
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 02/21/2011

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