MEDICARE: RIDGEPARK MEDICAL ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP09205	OH
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285609214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGEPARK MEDICAL ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1440 ROCKSIDE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2749
Country	:	US
Telephone Number	:	216-749-8276
Fax Number	:	216-749-8240

Provider Business Practice Location Address
First Line	:	1440 ROCKSIDE RD STE 202
Second Line	:
City	:	PARMA
State	:	OH
Zip	:	44134-2749
Country	:	US
Telephone Number	:	216-749-8276
Fax Number	:	216-749-8240

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES R KOEPKE
Credential	:	MD
Telephone Number	:	216-749-8276

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/10/2018

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