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General NPI Number Information
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NPI Number | 1588050215
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1766 CONNELLY SPRINGS RD
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City | LENOIR
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State | NC
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Zip | 28645-7827
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Country | US
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Telephone | 828-728-8224
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Fax | 828-728-1690
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Provider Business Mailing Address
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Address Line | 1766 CONNELLY SPRINGS RD
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City | LENOIR
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State | NC
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Zip | 28645-7827
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Country | US
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Telephone | 828-728-8224
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Fax | 828-728-1690
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Authorized Official
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Title or Position | SVP-CFO
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Name | PATRICIA MOLL
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Credential |
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Telephone | 828-580-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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