Provider Demographics
NPI:1518067867
Name:BLUE RIDGE CARDIOVASCULAR ASSOCIATES
Entity Type:Organization
Organization Name:BLUE RIDGE CARDIOVASCULAR ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-829-4374
Mailing Address - Street 1:440 SOUTHRIDGE PKWY
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3791
Mailing Address - Country:US
Mailing Address - Phone:540-829-4374
Mailing Address - Fax:540-829-4178
Practice Address - Street 1:440 SOUTHRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3791
Practice Address - Country:US
Practice Address - Phone:540-829-4374
Practice Address - Fax:540-829-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039420207RC0000X, 207UN0901X
VA0101240088207RC0000X
VA010139420207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA437749OtherBCBS GROUP
VA437749OtherBCBS GROUP
VAC08866Medicare PIN