Healthcare Provider Details

I. General information

NPI: 1285609214
Provider Name (Legal Business Name): RIDGEPARK MEDICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 ROCKSIDE RD STE 202
PARMA OH
44134-2749
US

IV. Provider business mailing address

1440 ROCKSIDE RD STE 202
PARMA OH
44134-2749
US

V. Phone/Fax

Practice location:
  • Phone: 216-749-8276
  • Fax: 216-749-8240
Mailing address:
  • Phone: 216-749-8276
  • Fax: 216-749-8240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP09205
License Number StateOH

VIII. Authorized Official

Name: CHARLES R KOEPKE
Title or Position: PRESIDENT
Credential: MD
Phone: 216-749-8276