Provider Demographics
NPI:1619025954
Name:BLUE RIDGE VEIN CARE, PC
Entity Type:Organization
Organization Name:BLUE RIDGE VEIN CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-947-0184
Mailing Address - Street 1:867 BURKS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-3201
Mailing Address - Country:US
Mailing Address - Phone:540-583-5191
Mailing Address - Fax:540-583-5192
Practice Address - Street 1:867 BURKS HILL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3201
Practice Address - Country:US
Practice Address - Phone:540-583-5191
Practice Address - Fax:540-583-5192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044001261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10109Medicare PIN
VAE48443Medicare UPIN