MEDICARE: BLUE RIDGE PAIN TREATMENT CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	0101059231	VA

General Provider Information

NPI Number	:	1306940028
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE PAIN TREATMENT CENTERS

Provider Business Mailing Address
First Line	:	2034 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-433-3300
Fax Number	:	540-433-7063

Provider Business Practice Location Address
First Line	:	2034 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-433-3300
Fax Number	:	540-433-7063

Authorized Official
Title or Position	:	PRACTICE OWNER
Name	:	JOHN E SHERRY II
Credential	:	M.D.
Telephone Number	:	540-560-2719

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	10/22/2011

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Practice Location Address:

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Practice Location Address:

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Practice Location Address:

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