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General NPI Number Information
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NPI Number | 1639243850
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE PAIN TREATMENT CTRS
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 2034 PRO POINTE LN
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City | HARRISONBURG
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State | VA
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Zip | 22801-8021
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Country | US
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Telephone | 540-801-8804
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Fax | 540-801-8828
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Provider Business Mailing Address
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Address Line | 2034 PRO POINTE LN
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City | HARRISONBURG
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State | VA
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Zip | 22801-8021
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Country | US
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Telephone | 540-801-8804
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Fax | 540-801-8828
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Authorized Official
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Title or Position | PAIN MANAGEMENT AND ANESTHEOLOGIST
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Name | MR. JOHN EH SHERRY II
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Credential | MD
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Telephone | 540-801-8804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0101059231
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License Number State | VA
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