Provider Demographics
NPI:1508560723
Name:BLUE RIDGE FAMILY MEDICAL PRACTICE
Entity Type:Organization
Organization Name:BLUE RIDGE FAMILY MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOSHIE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, NP-C
Authorized Official - Phone:423-470-0979
Mailing Address - Street 1:627 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-5401
Mailing Address - Country:US
Mailing Address - Phone:423-636-1521
Mailing Address - Fax:423-636-1523
Practice Address - Street 1:627 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-5401
Practice Address - Country:US
Practice Address - Phone:423-636-1521
Practice Address - Fax:423-636-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty