Basic Information
| Provider Information | |||||||||
| NPI: | 1013012764 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RIPLEY MEDICAL CLINIC INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 TUCKER AVE | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380631631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316354741 | ||||||||
| FaxNumber: | 7316353466 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 TUCKER AVE | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 380631631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7316354741 | ||||||||
| FaxNumber: | 7316608739 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOCKHOLT | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
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| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 7312211637 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.