NPIMap

Organization Active NPI

Ridge Road Medical Center PA

  • Family Medicine Physician
  • Rockwall, TX
National Provider Identifier
1366488512
Registry record updated Mar 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RIDGE ROAD MEDICAL CENTER PA
Practice address
2306 Ridge Rd
Rockwall, TX 75087-5140
Phone
(972) 771-8316
Fax
(972) 722-9214
NPI assigned
Jun 22, 2006
Last updated
Mar 26, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Carl K McKenney, DONPI 1225023831
Title
President
Phone
(972) 771-8316

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2306 Ridge Rd
Rockwall, TX 75087-5140

Mailing address

2306 Ridge Rd
Rockwall, TX 75087-5140
Phone (972) 771-8316

National Provider Directory

National Provider Directory

Locations

2306 Ridge Rd
Ste 2
Rockwall, TX 75087
Phone (972) 771-8316

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1269561600000",
    "number": "1366488512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2306 RIDGE RD",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875140",
            "telephone_number": "972-771-8316",
            "fax_number": "972-722-9214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 RIDGE RD",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750875140",
            "telephone_number": "972-771-8316",
            "fax_number": "972-722-9214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIDGE ROAD MEDICAL CENTER PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2010-03-26",
        "status": "A",
        "authorized_official_last_name": "MCKENNEY",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "972-771-8316",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockwall, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.