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General NPI Number Information
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NPI Number | 1588847982
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE FOOTCARE AND SURGERY PLC
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Dates
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Enumeration Date | 12/10/2007
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 30 CROSSING LN SUITE 105
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City | LEXINGTON
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State | VA
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Zip | 24450-6354
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Country | US
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Telephone | 540-463-6562
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Fax | 540-885-0016
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Provider Business Mailing Address
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Address Line | 30 CROSSING LN SUITE 105
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City | LEXINGTON
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State | VA
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Zip | 24450-6354
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Country | US
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Telephone | 540-463-6562
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Fax | 540-463-6562
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Authorized Official
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Title or Position | OWNER
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Name | THEODORE BARRY MCKEE
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Credential | D.P.M.
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Telephone | 540-463-6562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103300877
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License Number State | VA
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