Healthcare Provider Details

I. General information

NPI: 1316054802
Provider Name (Legal Business Name): BLUE RIDGE ENT & FACIAL SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CHERRY ST SUITE 205
BLUEFIELD WV
24701-3338
US

IV. Provider business mailing address

510 CHERRY ST SUITE 205
BLUEFIELD WV
24701-3338
US

V. Phone/Fax

Practice location:
  • Phone: 304-324-2954
  • Fax: 304-324-2955
Mailing address:
  • Phone: 304-324-2954
  • Fax: 304-324-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MARCH JONES JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 304-324-2954