Organization
RIDGEWOOD SURGERY AND ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER B BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
(615) 234-5954
Entity
Organization
Contact information
Practice address
4013 NORTH RIDGE ROAD, WICHITA, KS 67205-8822
(913) 314-9193
Mailing address
4013 NORTH RIDGE ROAD, WICHITA, KS 67205-8822
(913) 314-9193
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112228
BLUE CROSS BLUE SHIELD KS
KS
05
—
200504040A
—
KS
01
—
P00428555
RAILROAD MEDICARE
—
Enumeration date
01/31/2007
Last updated
08/01/2024
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