Basic Information
| Provider Information | |||||||||
| NPI: | 1205830163 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH RIDGE EMERGENCY PHYSICIANS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 551014 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336551014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004768646 | ||||||||
| FaxNumber: | 9193823210 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 N DIXIE HWY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333344135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547766000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | NICHOL | ||||||||
| AuthorizedOfficialFirstName: | CURRIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9547766000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | GROUP #CN0027 | 01 | NC | RAILROAD MEDICARE | OTHER | 72076 | 01 | FL | GROUP # BCBS OF FL 72076 | OTHER |