Healthcare Provider Details

I. General information

NPI: 1811244726
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

695 W FLEMING DR
MORGANTON NC
28655-4450
US

IV. Provider business mailing address

695 W FLEMING DR
MORGANTON NC
28655-4450
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-3278
  • Fax: 828-580-3279
Mailing address:
  • Phone: 828-580-3278
  • Fax: 828-580-3279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

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