1710129564 NPI number — BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.

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 1710129564 NPI number — BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLUE RIDGE HEALTHCARE MEDICAL GROUP, 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:
6
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:
1710129564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 S STERLING STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-580-4220
Provider Business Mailing Address Fax Number:
828-580-4229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
730 MALCOLM BLVD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
RUTHERFORD COLLEGE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-879-3572
Provider Business Practice Location Address Fax Number:
828-580-4229
Provider Enumeration Date:
03/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FRITTS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
SVP/CFO
Authorized Official Telephone Number:
828-580-5545

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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