Healthcare Provider Details

I. General information

NPI: 1013012764
Provider Name (Legal Business Name): RIPLEY MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 TUCKER AVE
RIPLEY TN
38063-1631
US

IV. Provider business mailing address

202 TUCKER AVE
RIPLEY TN
38063-1631
US

V. Phone/Fax

Practice location:
  • Phone: 731-635-4741
  • Fax: 731-660-8739
Mailing address:
  • Phone: 731-635-4741
  • Fax: 731-635-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HEIDI BOCKHOLT
Title or Position: COO
Credential:
Phone: 731-413-8584