1528324621 NPI number — BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528324621 NPI number — BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC
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:
INDUSTRIAL HEALTH
Provider Other Organization Name Type Code:
3
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:
1528324621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 316
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22124-0316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-521-8065
Provider Business Mailing Address Fax Number:
703-842-8416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 BELLE AIR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARRENTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20186-4368
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-347-9220
Provider Business Practice Location Address Fax Number:
540-347-0492
Provider Enumeration Date:
04/03/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HOLLIS
Authorized Official First Name:
JEFFRY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
540-347-9220

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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