Provider Demographics
NPI:1003230608
Name:/SVPBLUE RIDGE HEALTHCARE MEDCAL GROUP, INC
Entity Type:Organization
Organization Name:/SVPBLUE RIDGE HEALTHCARE MEDCAL GROUP, INC
Other - Org Name:BLUE RIDGE SURGICAL SPECIALISTS - MARION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO/SVP
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-580-5545
Mailing Address - Street 1:2209 S STERLING ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4091
Mailing Address - Country:US
Mailing Address - Phone:828-580-4230
Mailing Address - Fax:
Practice Address - Street 1:2209 S STERLING ST
Practice Address - Street 2:SUITE 440
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4091
Practice Address - Country:US
Practice Address - Phone:828-580-4230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01454208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty