Basic Information
Provider Information
NPI: 1295880557
EntityType: 2
ReplacementNPI:  
OrganizationName: BLUE RIDGE SURGICAL ASSOC., PC
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Mailing Information
Address1: 225 HOSPITAL DR
Address2:  
City: GALAX
State: VA
PostalCode: 243332228
CountryCode: US
TelephoneNumber: 2762366906
FaxNumber: 2762367179
Practice Location
Address1: 225 HOSPITAL DR
Address2:  
City: GALAX
State: VA
PostalCode: 243332228
CountryCode: US
TelephoneNumber: 2762366906
FaxNumber: 2762367179
Other Information
ProviderEnumerationDate: 01/24/2007
LastUpdateDate: 08/22/2020
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AuthorizedOfficialLastName: SWIGER
AuthorizedOfficialFirstName: SHELIA
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AuthorizedOfficialTitleorPosition: OFFICE MANAGER
AuthorizedOfficialTelephone: 2762366906
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansSurgery 

ID Information
IDTypeStateIssuerDescription
737475505VA MEDICAID
733528805VA MEDICAID


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