1134980451 NPI number — BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC

Table of content: (NPI 1134980451)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134980451 NPI number — BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE GEORGIA HOSPITAL COMPANY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134980451
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 RIVERSTONE VIS STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE RIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30513-6630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-258-4178
Provider Business Mailing Address Fax Number:
706-258-4146

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 BLUE RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MC CAYSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30555-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-492-3241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
EATON
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
HIM QUALITY DIR
Authorized Official Telephone Number:
706-632-4270

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com