Healthcare Provider Details

I. General information

NPI: 1245728864
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 GRACE CORPENING DR
MARION NC
28752
US

IV. Provider business mailing address

348 GRACE CORPENING DR
MARION NC
28752-5864
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-6821
  • Fax: 828-580-6822
Mailing address:
  • Phone: 828-580-6821
  • Fax: 828-580-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

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