Provider Demographics
NPI:1417186602
Name:BLUE RIDGE ULTRASOUND, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE ULTRASOUND, INC.
Other - Org Name:REGIONAL SONOGRAPHY SPECIALISTS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:RENEE'
Authorized Official - Last Name:CORZINE
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS, RVT
Authorized Official - Phone:828-452-0881
Mailing Address - Street 1:600 HOSPITAL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8046
Mailing Address - Country:US
Mailing Address - Phone:828-452-0881
Mailing Address - Fax:828-452-0883
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 4
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8024
Practice Address - Country:US
Practice Address - Phone:828-452-0881
Practice Address - Fax:828-452-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101697261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology