Healthcare Provider Details

I. General information

NPI: 1326450743
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2293 SUGAR HILL RD SUITE A
MARION NC
28752-7787
US

IV. Provider business mailing address

2293 SUGAR HILL RD SUITE A
MARION NC
28752-7787
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-1364
  • Fax: 828-655-2343
Mailing address:
  • Phone: 828-580-1364
  • Fax: 828-655-2343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number200100274
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MOLL
Title or Position: SVP-CFO
Credential:
Phone: 828-580-5003