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General NPI Number Information
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NPI Number | 1639563943
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE REGIONAL HOSPITAL
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Dates
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Enumeration Date | 03/25/2015
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Last Update Date | 03/25/2015
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Provider Practice Location Address
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Address Line | 189 HOSPITAL DR
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City | SPRUCE PINE
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State | NC
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Zip | 28777
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Country | US
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Telephone | 828-213-0048
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Fax |
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Provider Business Mailing Address
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Address Line | 509 BILTMORE AVE A158
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City | ASHEVILLE
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State | NC
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Zip | 28801-4601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TIMOTHY GENTILCORE
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Credential |
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Telephone | 828-213-0048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 12542
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License Number State | NC
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