Ridge Manor Medical Clinic | |
34498 Cortez Blvd Ridge Manor FL 33523-8908 | |
(352) 583-4520 | |
(352) 583-5527 |
Full Name | Ridge Manor Medical Clinic |
---|---|
Speciality | Clinic/Center |
Location | 34498 Cortez Blvd, Ridge Manor, Florida |
Authorized Official Name and Position | Basim Ahmed (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 3525681988 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Ridge Manor Medical Clinic 34498 Cortez Blvd Ridge Manor FL 33523-8908 Ph: (352) 583-4520 | Ridge Manor Medical Clinic 34498 Cortez Blvd Ridge Manor FL 33523-8908 Ph: (352) 583-4520 |
NPI Number | 1164568275 |
---|---|
Provider Enumeration Date | 01/29/2007 |
Last Update Date | 01/27/2011 |
Medicare PECOS PAC ID | 8426966854 |
---|---|
Medicare Enrollment ID | O20051118000564 |
Identifier | Type | State | Issuer |
---|---|---|---|
1164568275 | NPI | - | NPPES |
38227A | Other | FL | BCBS |
255718500 | Medicaid | FL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | ME0066026 (Florida) | Primary |
Provider Name | Mahmud Ahmed |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1619976198 PECOS PAC ID: 9335057769 Enrollment ID: I20070507000474 |
Provider Name | Juan P Lopez-gonzalez |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1225210685 PECOS PAC ID: 0749365716 Enrollment ID: I20190829001456 |
Provider Name | Brendalis Davila Rolon |
---|---|
Provider Type | Practitioner - General Practice |
Provider Identifiers | NPI Number: 1538531975 PECOS PAC ID: 5193025252 Enrollment ID: I20220207000755 |