Healthcare Provider Details

I. General information

NPI: 1942301957
Provider Name (Legal Business Name): BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2659 US HWY 70 E
VALDESE NC
28690-0008
US

IV. Provider business mailing address

2659 US 70 E
VALDESE NC
28690-9517
US

V. Phone/Fax

Practice location:
  • Phone: 828-580-4080
  • Fax: 828-580-4089
Mailing address:
  • Phone: 828-580-4080
  • Fax: 828-580-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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