Provider Demographics
NPI:1588847982
Name:BLUE RIDGE FOOTCARE AND SURGERY PLC
Entity Type:Organization
Organization Name:BLUE RIDGE FOOTCARE AND SURGERY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:540-463-6562
Mailing Address - Street 1:30 CROSSING LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-6354
Mailing Address - Country:US
Mailing Address - Phone:540-463-6562
Mailing Address - Fax:540-463-6562
Practice Address - Street 1:30 CROSSING LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-6354
Practice Address - Country:US
Practice Address - Phone:540-463-6562
Practice Address - Fax:540-885-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300877213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1336330620Medicaid
VA1336330620OtherTRICARE
1588847982OtherNPI GROUP LEXINGTON
VA1760426357OtherNPI INDIVIDUAL
VA6011470002OtherPTAN LEXINGTON
VADG6187OtherRR MEDICARE GROUP
VA1336330620OtherSOUTHERN HEALTH
1336330620OtherNPI GROUP STAUNTON
VA1336330620OtherVIRGINIA PREMIER
305227OtherANTHEM BCBS
1306888417OtherNPI INDIVIDUAL
305246OtherANTHEM BCBS
1588847982OtherNPI GROUP LEXINGTON
305246OtherANTHEM BCBS
VA1336330620Medicaid
VA6011470002OtherPTAN LEXINGTON
1336330620OtherNPI GROUP STAUNTON