Provider Demographics
NPI:1619119468
Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP
Entity Type:Organization
Organization Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP
Other - Org Name:BRHC RADIOLOGY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FRITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-580-5545
Mailing Address - Street 1:720 MALCOLM BLVD
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671
Mailing Address - Country:US
Mailing Address - Phone:828-879-7611
Mailing Address - Fax:828-879-7612
Practice Address - Street 1:720 MALCOLM BLVD
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671
Practice Address - Country:US
Practice Address - Phone:828-879-7611
Practice Address - Fax:828-879-7612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-25
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2327875AMedicare PIN