Healthcare Provider Details

I. General information

NPI: 1528394228
Provider Name (Legal Business Name): BLUE RIDGE UROLOGICAL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HEALTH CAMPUS DR STE 201
ROCKINGHAM VA
22801-8679
US

IV. Provider business mailing address

PO BOX 8310
ROANOKE VA
24014-0310
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-5900
  • Fax: 540-689-5602
Mailing address:
  • Phone: 540-345-3556
  • Fax: 540-342-2193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101033256
License Number StateVA

VIII. Authorized Official

Name: WILLIAM ROWLAND JONES
Title or Position: PRESIDENT
Credential: MD
Phone: 540-689-5900