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NPI Code Detail

MEDICARE: HEALTHRIDGE MEDICAL CENTER INC

MEDICARE: HEALTHRIDGE MEDICAL CENTER 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
1208000000XPediatrics Physician
2207R00000XInternal Medicine Physician
3363A00000XPhysician Assistant
4363LP0200XPediatric Nurse Practitioner
5207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1497717664
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEALTHRIDGE MEDICAL CENTER INC
Provider Business Mailing Address
First Line : 315 STRUTHERS LIBERTY RD
Second Line :
City : CAMPBELL
State : OH
Zip : 44405-1949
Country : US
Telephone Number : 330-750-1333
Fax Number : 330-750-0203
Provider Business Practice Location Address
First Line : 315 STRUTHERS LIBERTY RD
Second Line :
City : CAMPBELL
State : OH
Zip : 44405-1949
Country : US
Telephone Number : 330-750-1333
Fax Number : 330-750-0203
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : MS. VICKI LYNN MILLER
Credential :
Telephone Number : 330-750-1333
Provider Enumeration Date : 04/04/2006
Last Update Date : 12/09/2009

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Directions to “HEALTHRIDGE MEDICAL CENTER INC ” Practice Location

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