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NPI Code Detail

MEDICARE: THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC

MEDICARE: THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC
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
1261QA1903XAmbulatory Surgical Clinic/CenterASF-068SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477526689
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC
Provider Business Mailing Address
First Line : 10630 CLEMSON BLVD STE 200
Second Line :
City : SENECA
State : SC
Zip : 29678-4545
Country : US
Telephone Number : 864-482-5100
Fax Number : 864-482-9100
Provider Business Practice Location Address
First Line : 10630 CLEMSON BLVD STE 200
Second Line :
City : SENECA
State : SC
Zip : 29678-4545
Country : US
Telephone Number : 864-482-5100
Fax Number : 864-482-9100
Authorized Official
Title or Position : PRESIDENT
Name : MR. JEFFREY SNODGRASS
Credential :
Telephone Number : 615-665-1283
Provider Enumeration Date : 02/08/2006
Last Update Date : 06/22/2021

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Practice Location Address:
10630 CLEMSON BLVD STE 100
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Practice Fax: 864-482-7000
1780669432 — DR. JOHN F SLOBODA M.D.
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1225000573 — KYLE ERNEST WATFORD MD
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29678-4545
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Practice Fax:
1083673776 — BRIAN JAMES REDMOND M.D.
Practice Location Address:
10630 CLEMSON BLVD STE 100
SENECA, SC
29678-4545
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Practice Fax: 864-482-7000
1760441547 — LARRY STANLEY BOWMAN M.D.
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29678-4545
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1417917568 — STEVEN LEE MARTIN M.D.
Practice Location Address:
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Practice Fax: 864-482-7166

Directions to “THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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