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Organization

RIDGEWOOD PHYSICIAN SERVICES, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LISHA C FALK (VP OF CONTRACTING)
(337) 609-1221
Entity
Organization

Contact information

Practice address
40100 HIGHWAY 27, DAVENPORT, FL 33837-5906
(863) 422-4971
Mailing address
200 CORPORATE BLVD, LAFAYETTE, LA 70508-3870
(800) 893-9698

Taxonomy

Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101041300
FL
Enumeration date
08/28/2018
Last updated
03/23/2022
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