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Organization
RIDGE ROAD MEDICAL CENTER PA
Active
Organization
RIDGE ROAD MEDICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARL K MCKENNEY DO (PRESIDENT)
(972) 771-8316
Entity
Organization
Contact information
Practice address
2306 RIDGE RD, ROCKWALL, TX 75087-5140
(972) 771-8316
(972) 722-9214
Mailing address
2306 RIDGE RD, ROCKWALL, TX 75087-5140
(972) 771-8316
(972) 722-9214
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091844301
—
TX
05
—
091844302
—
TX
Enumeration date
06/22/2006
Last updated
03/26/2010
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