Healthcare Provider Details

I. General information

NPI: 1407203052
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 S STERLING ST STE 330
MORGANTON NC
28655-4093
US

IV. Provider business mailing address

2209 S STERLING ST STE 330
MORGANTON NC
28655-4093
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-5706
  • Fax: 828-580-8033
Mailing address:
  • Phone: 828-580-5706
  • Fax: 828-580-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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