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General NPI Number Information
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NPI Number | 1619025954
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE VEIN CARE, PC
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 12/30/2013
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Provider Practice Location Address
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Address Line | 867 BURKS HILL RD
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City | BEDFORD
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State | VA
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Zip | 24523-3201
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Country | US
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Telephone | 540-583-5191
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Fax | 540-583-5192
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Provider Business Mailing Address
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Address Line | 867 BURKS HILL RD
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City | BEDFORD
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State | VA
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Zip | 24523-3201
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Country | US
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Telephone | 540-583-5191
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Fax | 540-583-5192
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. KURT WILLIAM HUBACH
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Credential | M.D.
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Telephone | 540-947-0184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0101044001
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License Number State | VA
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