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General NPI Number Information
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NPI Number | 1033141502
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE ORTHOPAEDIC ASSOC PA
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Dates
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Enumeration Date | 07/07/2006
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 10630 CLEMSON BLVD SUITE 100
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City | SENECA
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State | SC
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Zip | 29678-4546
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Country | US
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Telephone | 864-482-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 10630 CLEMSON BLVD SUITE 100
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City | SENECA
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State | SC
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Zip | 29678-4545
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Country | US
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Telephone | 864-482-6000
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JO STOKES
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Credential |
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Telephone | 864-482-6165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State | SC
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