Healthcare Provider Details

I. General information

NPI: 1427482926
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 D MALCOLM BLVD.
RUTHERFORD COLLEGE NC
28671
US

IV. Provider business mailing address

PO BOX 601076
CHARLOTTE NC
28260-1076
US

V. Phone/Fax

Practice location:
  • Phone: 828-874-2731
  • Fax: 828-879-4888
Mailing address:
  • Phone: 828-874-2731
  • Fax: 828-879-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9442
License Number StateNC

VIII. Authorized Official

Name: ROBERT G FRITTS
Title or Position: SENIOR VICE-PRESIDENT
Credential:
Phone: 828-580-4220