Provider Demographics
NPI:1578618591
Name:BLUE RIDGE PAIN MANAGEMENT & PALLIATIVE CARE PA
Entity Type:Organization
Organization Name:BLUE RIDGE PAIN MANAGEMENT & PALLIATIVE CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BUZZANELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-350-9310
Mailing Address - Street 1:3 WALDEN RIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8587
Mailing Address - Country:US
Mailing Address - Phone:828-350-9310
Mailing Address - Fax:828-350-9311
Practice Address - Street 1:3 WALDEN RIDGE DR STE 100
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8587
Practice Address - Country:US
Practice Address - Phone:828-350-9310
Practice Address - Fax:828-350-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0098-00481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900458Medicaid
NC5900458Medicaid