Provider Demographics
NPI:1326450743
Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC
Other - Org Name:BLUE RIDGE CARDIOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-580-5003
Mailing Address - Street 1:2293 SUGAR HILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-7787
Mailing Address - Country:US
Mailing Address - Phone:828-580-1364
Mailing Address - Fax:828-655-2343
Practice Address - Street 1:2293 SUGAR HILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-7787
Practice Address - Country:US
Practice Address - Phone:828-580-1364
Practice Address - Fax:828-655-2343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RC0000X
NC200100274207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty