Provider Demographics
NPI:1609833664
Name:BLUE RIDGE PLASTIC SURGERY GROUP, PLLC
Entity Type:Organization
Organization Name:BLUE RIDGE PLASTIC SURGERY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAMON
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANAGNOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-268-0082
Mailing Address - Street 1:141 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5017
Mailing Address - Country:US
Mailing Address - Phone:828-268-0082
Mailing Address - Fax:828-268-0087
Practice Address - Street 1:141 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5017
Practice Address - Country:US
Practice Address - Phone:828-268-0082
Practice Address - Fax:828-268-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600439208600000X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911088Medicaid
NC11088OtherSTATE HEALTH PLAN
NCP00054841OtherRAILROAD MEDICARE
NC0262412002OtherCIGNA
NC11088OtherBCBS
NC1300361OtherUNITED HEALTH CARE
NCC5607OtherMEDCOST
NC11088OtherSTATE HEALTH PLAN
NC=========OtherHEALTHCARE SAVINGS
NCC5607OtherMEDCOST
NC11088OtherBCBS
NC1300361OtherUNITED HEALTH CARE