Provider Demographics
NPI:1629419452
Name:BLUEROCK MEDICAL LLC
Entity Type:Organization
Organization Name:BLUEROCK MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-437-4895
Mailing Address - Street 1:3152 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4745
Mailing Address - Country:US
Mailing Address - Phone:801-437-4895
Mailing Address - Fax:801-229-1003
Practice Address - Street 1:3152 N UNIVERSITY AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4745
Practice Address - Country:US
Practice Address - Phone:801-437-4895
Practice Address - Fax:801-229-1003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty