| Ridge Creek Family Practice | |
|
15190 Badger Ranch Blvd Ste 102 Woodway TX 76712-8984 | |
| (254) 301-7166 | |
| (254) 824-3297 |
| Full Name | Ridge Creek Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 15190 Badger Ranch Blvd Ste 102, Woodway, Texas |
| Authorized Official Name and Position | Carrie A Johnson (OWNER) |
| Authorized Official Contact | 2543017166 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridge Creek Family Practice 15190 Badger Ranch Blvd Ste 102 Woodway TX 76712-8984 Ph: (254) 301-7166 | Ridge Creek Family Practice 15190 Badger Ranch Blvd Ste 102 Woodway TX 76712-8984 Ph: (254) 301-7166 |
| NPI Number | 1851038350 |
|---|---|
| Provider Enumeration Date | 05/16/2022 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 1658750922 |
|---|---|
| Medicare Enrollment ID | O20220616000215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851038350 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Carrie A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316071624 PECOS PAC ID: 5294836466 Enrollment ID: I20070718000767 |
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