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General NPI Number Information
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NPI Number | 1417186602
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE ULTRASOUND, INC.
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Dates
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Enumeration Date | 07/08/2009
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Last Update Date | 09/18/2009
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Provider Practice Location Address
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Address Line | 600 HOSPITAL DR SUITE 4
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City | CLYDE
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State | NC
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Zip | 28721-8024
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Country | US
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Telephone | 828-452-0881
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Fax | 828-452-0883
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Provider Business Mailing Address
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Address Line | 600 HOSPITAL DR STE 4
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City | CLYDE
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State | NC
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Zip | 28721-8046
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Country | US
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Telephone | 828-452-0881
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Fax | 828-452-0883
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TAMMY RENEE' CORZINE
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Credential | RDMS, RVT
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Telephone | 828-452-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 101697
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License Number State | NC
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