MEDICARE: BLUE RIDGE ECHO, 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
1	2085U0001X	Diagnostic Ultrasound Physician

General Provider Information

NPI Number	:	1871529859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE ECHO, LLC

Provider Business Mailing Address
First Line	:	3421 CANTER CIR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3801
Country	:	US
Telephone Number	:	540-588-7214
Fax Number	:

Provider Business Practice Location Address
First Line	:	3421 CANTER CIR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3801
Country	:	US
Telephone Number	:	540-588-7214
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DONNA J WHICHARD
Credential	:
Telephone Number	:	540-588-7214

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/22/2020

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