# RIDGE MANOR FAMILY CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730577115
- **Authorized official:** DR. GOPAL R KORUPOLU M.D. (PHYSICIAN/OWNER)
- **Authorized official phone:** (352) 799-3449

## Contact information

- **Practice address:** 12204 CORTEZ BLVD, BROOKSVILLE, FL 34613-2630
- **Practice address phone:** (352) 799-3449
- **Practice address fax:** (352) 799-3214
- **Mailing address:** PO BOX 15781, BROOKSVILLE, FL 34604-0124
- **Mailing address phone:** (352) 799-3449
- **Mailing address fax:** (352) 799-3214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME0070951 | FL | Yes |

## Other

- **Enumeration date:** 01/07/2015
- **Last updated:** 02/10/2015