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General NPI Number Information
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NPI Number | 1861743007
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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 | 09/27/2012
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Last Update Date | 06/19/2013
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Provider Practice Location Address
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Address Line | 2201 S STERLING ST
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City | MORGANTON
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State | NC
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Zip | 28655-4044
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Country | US
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Telephone | 828-580-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 103 MEDICAL HEIGHTS DR
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City | MORGANTON
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State | NC
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Zip | 28655-5197
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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 | SVP/CFO
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Name | ROBERT G FRITTS
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Credential |
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Telephone | 828-580-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 28077
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License Number State | NC
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