=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437246881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLUE RIDGE RESPIRATORY AND MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2006
-----------------------------------------------------
Last Update Date | 04/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2225 LANGHORNE RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-316-9115
-----------------------------------------------------
Fax | 434-455-7166
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2225 LANGHORNE RD
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-1107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-316-9115
-----------------------------------------------------
Fax | 434-455-7166
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RICHARD GILMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 434-316-9112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | S2012724
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------