Organization
RIDGEPARK MEDICAL ASSOCIATES, INC.
Active
Organization
RIDGEPARK MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES ROBERT KOEPKE M.D. (PRESIDENT)
(216) 749-8256
Entity
Organization
Contact information
Practice address
7575 NORTHCLIFF AVE, LABORATORY SUITE 106, BROOKLYN, OH 44144-3267
(216) 398-5095
(216) 398-5119
Mailing address
7575 NORTHCLIFF AVE, LABORATORY SUITE 106, BROOKLYN, OH 44144-3267
(216) 398-5095
(216) 398-5119
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
36D0338463
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000561755
ANTHEM
—
05
—
2754274
—
OH
01
—
512593
WELLCAREOF OH
OH
Enumeration date
08/07/2006
Last updated
08/31/2011
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