Healthcare Provider Details

I. General information

NPI: 1891883989
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 MAIN AVE. WEST
HILDEBRAN NC
28637
US

IV. Provider business mailing address

517 MAIN AVE. WEST
HILDEBRAN NC
28637
US

V. Phone/Fax

Practice location:
  • Phone: 828-397-5561
  • Fax: 828-397-3226
Mailing address:
  • Phone: 828-397-5561
  • Fax: 828-397-3226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT FRITTS
Title or Position: SVP/CFO
Credential:
Phone: 828-580-5455