Healthcare Provider Details

I. General information

NPI: 1922046820
Provider Name (Legal Business Name): BLOWING ROCK MEDICAL CLINIC PR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 CHESTNUT DRIVE
BLOWING ROCK NC
28605-0008
US

IV. Provider business mailing address

PO BOX 8
BLOWING ROCK NC
28605-0008
US

V. Phone/Fax

Practice location:
  • Phone: 828-295-3116
  • Fax: 828-295-4388
Mailing address:
  • Phone: 828-295-3116
  • Fax: 828-295-4388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SYLVIA F BURNS
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-295-3116