=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720220379
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RIDGE PARK URGENT CARE, LLC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2009
-----------------------------------------------------
Last Update Date | 10/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7580 NORTHCLIFF AVE SUITE 700
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44144-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-886-1800
-----------------------------------------------------
Fax | 216-741-5825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7580 NORTHCLIFF AVE SUITE 700
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44144-3270
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-886-1800
-----------------------------------------------------
Fax | 216-741-5825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. CHRISTOPHER K SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-356-9844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------