Ridge Lake Asc, Llc

LBN: Ridge Lake Asc, Llc
Ridge Lake Asc, Llc is an health care organization with primary practice located at 825 Ridge Lake Blvd , Memphis TN 38120-9411. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Ambulatory Surgical, Ambulatory Health Care Facilities / Ophthalmologic Surgery. Ambulatory Health Care Facilities / Ophthalmologic Surgery is the primary health care specialty. Ridge Lake Asc, Llc can be contacted via phone (901) 685-2200, or through Gollamudi, Subba R via phone (901) 685-2200.

Contact Information

Primary practice address
825 Ridge Lake Blvd Memphis TN 38120-9411
Phone: (901) 685-2200
Fax: (901) 820-2342
Website:
Map and Directions
Authorized official contact:
Name: Gollamudi, Subba R Doctor of Medicine (MD)
Phone: (901) 685-2200

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Ambulatory Surgical 261QA1903X 0000000049 Tennessee
Ambulatory Health Care Facilities / Ophthalmologic Surgery 261QS0132X 0000000049 Tennessee

Profile Details

NPI number 1790844132
LBN Legal business name Ridge Lake Asc, Llc
DBA Doing business as
Authorized official Gollamudi, Subba R Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 8th, 2006
Last updated Jul 25th, 2022 - about 2 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790844132 NPPES
Tennessee MEDICAID Q016777
Tennessee MEDICAID 00074013
Tennessee MEDICAID 190552128

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