Provider Demographics
NPI:1376222356
Name:ASHE MULTISPECIALTY GROUP, LLC
Entity Type:Organization
Organization Name:ASHE MULTISPECIALTY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PRACTICE MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BRODEUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-846-7101
Mailing Address - Street 1:200 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-846-0821
Mailing Address - Fax:
Practice Address - Street 1:2635 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:MOUTH OF WILSON
Practice Address - State:VA
Practice Address - Zip Code:24363-3004
Practice Address - Country:US
Practice Address - Phone:336-846-0805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASHE MULTISPECIALTY GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty