MEDICARE: BLUE RIDGE PAIN TREATMENT CTRS

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	305R00000X	Preferred Provider Organization	0101059231	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1639243850
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE PAIN TREATMENT CTRS

Provider Business Mailing Address
First Line	:	2034 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-801-8804
Fax Number	:	540-801-8828

Provider Business Practice Location Address
First Line	:	2034 PRO POINTE LN
Second Line	:
City	:	HARRISONBURG
State	:	VA
Zip	:	22801-8021
Country	:	US
Telephone Number	:	540-801-8804
Fax Number	:	540-801-8828

Authorized Official
Title or Position	:	PAIN MANAGEMENT AND ANESTHEOLOGIST
Name	:	MR. JOHN EH SHERRY II
Credential	:	MD
Telephone Number	:	540-801-8804

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	09/16/2008

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