Basic Information
| Provider Information | |||||||||
| NPI: | 1619368313 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RIEFKOHL ORTIZ | ||||||||
| FirstName: | ELAINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | RIEFKOHL ORTIZ | ||||||||
| OtherFirstName: | ELAINE | ||||||||
| OtherMiddleName: | JANICE | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3730 TABS DR | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446859562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305630618 | ||||||||
| FaxNumber: | 3305630604 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 23RD ST | ||||||||
| Address2: | |||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442231404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305630618 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2015 | ||||||||
| LastUpdateDate: | 03/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 31555R | PR | N | Hospitals | General Acute Care Hospital | 207P00000X | 130887 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 31555R | 01 | PR | LISCENCE | OTHER | 0231300 | 05 | OH | MEDICAID |