Healthcare Provider Details

I. General information

NPI: 1376569343
Provider Name (Legal Business Name): BLUE RIDGE ORTHOPAEDIC ASSOC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HEALTHY WAY SUITE 1200
ANDERSON SC
29621-7916
US

IV. Provider business mailing address

10630 CLEMSON BLVD SUITE 100
SENECA SC
29678-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-6000
  • Fax:
Mailing address:
  • Phone: 864-260-9910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JO STOKES
Title or Position: ADMINISTRATOR
Credential:
Phone: 864-482-6165