Basic Information
| Provider Information | |||||||||
| NPI: | 1679570840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUE RIDGE REGIONAL HOSPITAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9 | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287770009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287654201 | ||||||||
| FaxNumber: | 8287650824 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | SPRUCE PINE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287773035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8287654201 | ||||||||
| FaxNumber: | 8287650824 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2005 | ||||||||
| LastUpdateDate: | 04/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | JONATHAN | ||||||||
| AuthorizedOfficialMiddleName: | CARL | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8287661740 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | 282NR1301X | H0169 | NC | Y | Hospitals | General Acute Care Hospital | Rural |
ID Information
| ID | Type | State | Issuer | Description | 235013B | 01 | NC | MEDICARE PROFESSIONAL | OTHER | 3400011 | 05 | NC | MEDICAID | CA1796 | 01 | NC | MEDICARE RAILROAD | OTHER | 00513 | 01 | NC | BCBSNC | OTHER | 235013 | 01 | NC | MEDICARE PROFESSIONAL | OTHER | 34750011 | 01 | NC | MEDICAID SWINGBED | OTHER | 411013849 | 01 | NC | MEDICARE RAILROAD | OTHER | 8000306 | 01 | NC | MEDICAID CRNA | OTHER | 8907673 | 01 | NC | MEDICAID PROFESSIONAL | OTHER | C30677 | 01 | NC | MEDICARE RAILROAD | OTHER | 2612160 | 01 | NC | MEDICARE CRNA | OTHER | 014MX | 01 | NC | BCBSNC LABS | OTHER | 07673 | 01 | NC | BCBSNC PROFESSIONAL | OTHER | 430001766 | 01 | NC | MEDICARE RAILROAD | OTHER |