| Ridge Family Practice, Pc | |
|
201 Ridge St Suite 201 Council Bluffs IA 51503-4643 | |
| (712) 322-5899 | |
| (712) 322-5730 |
| Full Name | Ridge Family Practice, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 201 Ridge St, Council Bluffs, Iowa |
| Authorized Official Name and Position | Angela L Lund (OFFICE MANAGER) |
| Authorized Official Contact | 7123225899 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridge Family Practice, Pc 201 Ridge St Ste 311 Council Bluffs IA 51503-4643 Ph: (712) 322-5899 | Ridge Family Practice, Pc 201 Ridge St Suite 201 Council Bluffs IA 51503-4643 Ph: (712) 322-5899 |
| NPI Number | 1053300020 |
|---|---|
| Provider Enumeration Date | 10/20/2005 |
| Last Update Date | 02/21/2022 |
| Medicare PECOS PAC ID | 2769372382 |
|---|---|
| Medicare Enrollment ID | O20040317001328 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053300020 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Clarine I Coker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720078637 PECOS PAC ID: 7315079944 Enrollment ID: I20100719000075 |
| Provider Name | Caitlin Smith Walter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124782941 PECOS PAC ID: 4183014798 Enrollment ID: I20211213002653 |
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