| Ridge Road Medical Center Pa | |
|
2306 Ridge Rd Rockwall TX 75087-5140 | |
| (972) 771-8316 | |
| (972) 722-9214 |
| Full Name | Ridge Road Medical Center Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 2306 Ridge Rd, Rockwall, Texas |
| Authorized Official Name and Position | Carl K Mckenney (PRESIDENT) |
| Authorized Official Contact | 9727718316 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ridge Road Medical Center Pa 2306 Ridge Rd Rockwall TX 75087-5140 Ph: (972) 771-8316 | Ridge Road Medical Center Pa 2306 Ridge Rd Rockwall TX 75087-5140 Ph: (972) 771-8316 |
| NPI Number | 1366488512 |
|---|---|
| Provider Enumeration Date | 06/22/2006 |
| Last Update Date | 03/26/2010 |
| Medicare PECOS PAC ID | 3577660414 |
|---|---|
| Medicare Enrollment ID | O20070529000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366488512 | NPI | - | NPPES |
| 091844301 | Medicaid | TX | |
| 091844302 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Carl K Mckenney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225023831 PECOS PAC ID: 4183721020 Enrollment ID: I20100826001112 |
| Provider Name | Jennifer Marie Schoenfeld |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1265026801 PECOS PAC ID: 8729495387 Enrollment ID: I20210325002437 |
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