Provider Demographics
NPI:1326018649
Name:BLOWING ROCK HOSPITAL
Entity Type:Organization
Organization Name:BLOWING ROCK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP MEDICAL STAFF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA-CPMSM
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:418 CHESTNUT CIR
Mailing Address - Street 2:P.P. BOX 148
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-9216
Mailing Address - Country:US
Mailing Address - Phone:828-295-3136
Mailing Address - Fax:
Practice Address - Street 1:418 CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-9216
Practice Address - Country:US
Practice Address - Phone:828-295-3136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA0600X, 261QC0050X, 261QE0002X, 261QP2000X, 261QR0400X, 261QU0200X, 275N00000X, 291U00000X
NCH0160282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3414822OtherNCPDP NUMBER
NC3401321Medicaid
NC2352745Medicare ID - Type UnspecifiedPART B
NC341321Medicare Oscar/Certification