Healthcare Provider Details

I. General information

NPI: 1871529859
Provider Name (Legal Business Name): BLUE RIDGE ECHO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 CANTER CIR
ROANOKE VA
24018-3801
US

IV. Provider business mailing address

3421 CANTER CIR
ROANOKE VA
24018-3801
US

V. Phone/Fax

Practice location:
  • Phone: 540-588-7214
  • Fax:
Mailing address:
  • Phone: 540-588-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA J WHICHARD
Title or Position: CEO
Credential:
Phone: 540-588-7214