Provider Demographics
NPI:1437246881
Name:BLUE RIDGE RESPIRATORY AND MEDICAL
Entity Type:Organization
Organization Name:BLUE RIDGE RESPIRATORY AND MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-316-9112
Mailing Address - Street 1:2225 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1107
Mailing Address - Country:US
Mailing Address - Phone:434-316-9115
Mailing Address - Fax:434-455-7166
Practice Address - Street 1:2225 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1107
Practice Address - Country:US
Practice Address - Phone:434-316-9115
Practice Address - Fax:434-455-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS2012724332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10404720Medicaid
VA5859780001Medicare NSC