Basic Information
| Provider Information | |||||||||
| NPI: | 1457308827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EMERGEORTHO, PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BLUE RIDGE BONE & JOINT CLINIC, PA | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 MCDOWELL ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8282817178 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 MCDOWELL ST | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288014434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282588800 | ||||||||
| FaxNumber: | 8282817178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 11/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | DIMMIG | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
| AuthorizedOfficialMiddleName: | ALVA | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9192205255 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 11/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 38818 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 890124B | 05 | NC | MEDICAID | 38818 | 01 | NC | NCMB REG. NUMBER | OTHER | 0124B | 01 | NC | GROUP BCBS NC | OTHER |