MEDICARE: BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02082	OTHER	NC	BLUE CROSS BLUE SHIELD OF NC
2	34D0947561	OTHER	NC	CLIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710211560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	5920 US HIGHWAY 70 E
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-9565
Country	:	US
Telephone Number	:	828-659-9703
Fax Number	:	828-652-8793

Provider Business Practice Location Address
First Line	:	5920 US HIGHWAY 70 E
Second Line	:
City	:	NEBO
State	:	NC
Zip	:	28761-9565
Country	:	US
Telephone Number	:	828-652-8727
Fax Number	:	828-652-8793

Authorized Official
Title or Position	:	SVP-CFO
Name	:	PATRICIA MOLL
Credential	:
Telephone Number	:	828-580-5003

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	03/12/2025

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Directions to “BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC. ” Practice Location

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