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General NPI Number Information
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NPI Number | 1699197012
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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 | 01/21/2014
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 720 MALCOLM BLVD SUITE 200
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City | CONNELLY SPRINGS
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State | NC
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Zip | 28612-7920
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Country | US
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Telephone | 828-580-7536
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Fax | 828-580-7537
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Provider Business Mailing Address
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Address Line | 720 MALCOLM BLVD SUITE 200
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City | CONNELLY SPRINGS
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State | NC
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Zip | 28612-7920
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Country | US
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Telephone | 828-580-7536
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Fax | 828-580-7537
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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 | 207RH0000X
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Taxonomy Name | Hematology (Internal Medicine) Physician
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License Number | 2009-00695
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License Number State | NC
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