| Ridge Manor Family Clinic Inc | |
|
12204 Cortez Blvd Brooksville FL 34613-2630 | |
| (352) 799-3449 | |
| (352) 799-3214 |
| Full Name | Ridge Manor Family Clinic Inc |
|---|---|
| Speciality | General Practice |
| Location | 12204 Cortez Blvd, Brooksville, Florida |
| Authorized Official Name and Position | Gopal R Korupolu (PHYSICIAN/OWNER) |
| Authorized Official Contact | 3527993449 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridge Manor Family Clinic Inc Po Box 15781 Brooksville FL 34604-0124 Ph: (352) 799-3449 | Ridge Manor Family Clinic Inc 12204 Cortez Blvd Brooksville FL 34613-2630 Ph: (352) 799-3449 |
| NPI Number | 1730577115 |
|---|---|
| Provider Enumeration Date | 01/07/2015 |
| Last Update Date | 02/10/2015 |
| Medicare PECOS PAC ID | 0446576672 |
|---|---|
| Medicare Enrollment ID | O20150306001192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730577115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | ME0070951 (Florida) | Primary |
| Provider Name | Gopal R Korupolu |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1861437428 PECOS PAC ID: 4880613918 Enrollment ID: I20101013000894 |
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