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General NPI Number Information
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NPI Number | 1730112434
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Entity Type | Organization
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Legal Business Name | BLUE RIDGE SURGICAL GROUP, PA
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 838 STATE FARM ROAD, SUITE 1
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City | BOONE
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State | NC
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Zip | 28607
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Country | US
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Telephone | 828-268-0688
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Fax | 828-268-0413
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Provider Business Mailing Address
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Address Line | 838 STATE FARM ROAD, SUITE 1
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City | BOONE
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State | NC
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Zip | 28607
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Country | US
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Telephone | 828-268-0688
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Fax | 828-268-0413
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SHERRI BOOTHE
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Credential |
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Telephone | 828-268-0688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 9500690
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License Number State | NC
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