Healthcare Provider Details

I. General information

NPI: 1477526689
Provider Name (Legal Business Name): THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 CLEMSON BLVD STE 200
SENECA SC
29678-4545
US

IV. Provider business mailing address

10630 CLEMSON BLVD STE 200
SENECA SC
29678-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-5100
  • Fax: 864-482-9100
Mailing address:
  • Phone: 864-482-5100
  • Fax: 864-482-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberASF-068
License Number StateSC

VIII. Authorized Official

Name: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283