1679570840 NPI number — BLUE RIDGE REGIONAL HOSPITAL INC

Table of content: (NPI 1679570840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679570840 NPI number — BLUE RIDGE REGIONAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE REGIONAL HOSPITAL INC
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:
1679570840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRUCE PINE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28777-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-765-4201
Provider Business Mailing Address Fax Number:
828-765-0824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRUCE PINE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28777-3035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-765-4201
Provider Business Practice Location Address Fax Number:
828-765-0824
Provider Enumeration Date:
07/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
CARL
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
828-766-1740

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NR1301X , with the licence number: H0169 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 235013B . This is a "MEDICARE PROFESSIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3400011 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA1796 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00513 . This is a "BCBSNC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 235013 . This is a "MEDICARE PROFESSIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 34750011 . This is a "MEDICAID SWINGBED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 411013849 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8000306 . This is a "MEDICAID CRNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8907673 . This is a "MEDICAID PROFESSIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C30677 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2612160 . This is a "MEDICARE CRNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 014MX . This is a "BCBSNC LABS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 07673 . This is a "BCBSNC PROFESSIONAL" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 430001766 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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