Healthcare Provider Details

I. General information

NPI: 1225508278
Provider Name (Legal Business Name): BLUE RIDGE MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16658 MORGANTON HWY
MORGANTON GA
30560-4144
US

IV. Provider business mailing address

16658 MORGANTON HWY
MORGANTON GA
30560-4144
US

V. Phone/Fax

Practice location:
  • Phone: 706-633-8086
  • Fax:
Mailing address:
  • Phone: 706-633-8086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DAVID RYAN MCDARIS
Title or Position: OWNER
Credential: PRMDC
Phone: 706-633-8086