MEDICARE: BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician	NC
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	NC
3	207RC0000X	Cardiovascular Disease Physician	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0286K	OTHER	NC	BCBS OF NC GROUP NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	21388	OTHER	NC	MEDCOST GROUP NUMBER

General Provider Information

NPI Number	:	1851363311
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA

Provider Business Mailing Address
First Line	:	PO BOX 249
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-0249
Country	:	US
Telephone Number	:	336-679-4963
Fax Number	:	336-679-2549

Provider Business Practice Location Address
First Line	:	640 PARKWOOD MEDICAL PARK
Second Line	:
City	:	ELKIN
State	:	NC
Zip	:	28621-2487
Country	:	US
Telephone Number	:	336-526-7997
Fax Number	:	336-526-3537

Authorized Official
Title or Position	:	CEO
Name	:	DR. TOMAS VYBIRAL
Credential	:	M.D.
Telephone Number	:	336-526-7997

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	08/23/2013

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1740285824 — DR. TOMAS VYBIRAL M.D.
Practice Location Address:

640 PARKWOOD MEDICAL PARK
ELKIN, NC
28621-2487

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1700858404 — DR. TAMAS SOOS M.D.
Practice Location Address:

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1578524070 — MS. CRYSTAL BLEVINS LUFFMAN APRN, PMHNP
Practice Location Address:

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ELKIN, NC
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1033149760 — DARRYL B. RHYNE, MD, PLLC
Practice Location Address:

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1336210921 — PIEDMONT FOOT AND ANKLE ASSOCIATES, P. C.
Practice Location Address:

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1891852638 — ROBERT GOODLOE PETERSON M.D.
Practice Location Address:

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Directions to “BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA ” Practice Location

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