Healthcare Provider Details

I. General information

NPI: 1962635540
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
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 530
MORGANTON NC
28655-4093
US

IV. Provider business mailing address

2209 S STERLING ST STE 530
MORGANTON NC
28655-4093
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-4230
  • Fax: 828-580-4239
Mailing address:
  • Phone: 828-580-4230
  • Fax: 828-580-4239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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