Healthcare Provider Details

I. General information

NPI: 1952342107
Provider Name (Legal Business Name): RIDGE MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 1002
LINTON IN
47441-9497
US

IV. Provider business mailing address

RR 1 BOX 1002
LINTON IN
47441-9497
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-4481
  • Fax: 812-847-0197
Mailing address:
  • Phone: 812-847-4481
  • Fax: 812-847-0197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SAM ROBERTS
Title or Position: OFFICE MANAGER
Credential:
Phone: 812-847-4481