Basic Information
| Provider Information | |||||||||
| NPI: | 1730472671 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC. | ||||||||
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| OtherOrganizationName: | BLUE RIDGE MEDCIAL GROUP - NEUROLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2209 S STERLING ST STE 330 | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286554093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285808100 | ||||||||
| FaxNumber: | 8285808101 | ||||||||
| Practice Location | |||||||||
| Address1: | 2209 S STERLING ST STE 330 | ||||||||
| Address2: | |||||||||
| City: | MORGANTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286554093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285808100 | ||||||||
| FaxNumber: | 8285808101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2011 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| AuthorizedOfficialLastName: | FRITTS | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8285805545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No ID Information.