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General NPI Number Information
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NPI Number | 1407865488
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Entity Type | Organization
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Legal Business Name | RIDGEPARK MEDICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 08/31/2011
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Provider Practice Location Address
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Address Line | 7575 NORTHCLIFF AVE LABORATORY SUITE 106
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City | BROOKLYN
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State | OH
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Zip | 44144-3267
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Country | US
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Telephone | 216-398-5095
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Fax | 216-398-5119
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Provider Business Mailing Address
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Address Line | 7575 NORTHCLIFF AVE LABORATORY SUITE 106
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City | BROOKLYN
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State | OH
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Zip | 44144-3267
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Country | US
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Telephone | 216-398-5095
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Fax | 216-398-5119
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES ROBERT KOEPKE
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Credential | M.D.
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Telephone | 216-749-8256
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 36D0338463
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License Number State | OH
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