Provider Demographics
NPI:1477526689
Name:THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC
Entity Type:Organization
Organization Name:THE BLUE RIDGE CLEMSON ORTHOPAEDIC ASC LLC
Other - Org Name:BLUE RIDGE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGRASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:10630 CLEMSON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-4545
Mailing Address - Country:US
Mailing Address - Phone:864-482-5100
Mailing Address - Fax:864-482-9100
Practice Address - Street 1:10630 CLEMSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-4545
Practice Address - Country:US
Practice Address - Phone:864-482-5100
Practice Address - Fax:864-482-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCASF-068261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCASC040Medicaid
SC=========OtherHUMANA
SC42C0001044Medicare Oscar/Certification
SC=========OtherHUMANA
SC490005581Medicare PIN