MEDICARE: BLOWING ROCK MEDICAL CLINIC PR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1922046820
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOWING ROCK MEDICAL CLINIC PR

Provider Business Mailing Address
First Line	:	PO BOX 8
Second Line	:
City	:	BLOWING ROCK
State	:	NC
Zip	:	28605-0008
Country	:	US
Telephone Number	:	828-295-3116
Fax Number	:	828-295-4388

Provider Business Practice Location Address
First Line	:	366 CHESTNUT DRIVE
Second Line	:
City	:	BLOWING ROCK
State	:	NC
Zip	:	28605-0008
Country	:	US
Telephone Number	:	828-295-3116
Fax Number	:	828-295-4388

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. SYLVIA F BURNS
Credential	:
Telephone Number	:	828-295-3116

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/20/2011

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