BLUE RIDGE REGIONAL HOSPITAL INC

Provider Demographics

• NPI: 1679570840
• Name: BLUE RIDGE REGIONAL HOSPITAL INC
• Entity Type: Organization
• Organization Name: BLUE RIDGE REGIONAL HOSPITAL INC
• Authorized Official - Title/Position: CFO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: JONATHAN
• Authorized Official - Middle Name: CARL
• Authorized Official - Last Name: SMITH
• Authorized Official - Phone: 828-766-1740
• Mailing Address - Street 1: PO BOX 9
• Mailing Address - City: SPRUCE PINE
• Mailing Address - State: NC
• Mailing Address - Zip Code: 28777-0009
• Mailing Address - Country: US
• Mailing Address - Phone: 828-765-4201
• Mailing Address - Fax: 828-765-0824
• Practice Address - Street 1: 125 HOSPITAL DR
• Practice Address - City: SPRUCE PINE
• Practice Address - State: NC
• Practice Address - Zip Code: 28777-3035
• Practice Address - Country: US
• Practice Address - Phone: 828-765-4201
• Practice Address - Fax: 828-765-0824
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-07-04
• Last Update Date: 2009-04-10

Provider Licenses

State	License ID	Taxonomies
		207P00000X
NC	H0169	282NR1301X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	282NR1301X	Hospitals	General Acute Care Hospital	Rural
No	207P00000X	Allopathic & Osteopathic Physicians	Emergency Medicine		Group - Single Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NC	235013B	Other	MEDICARE PROFESSIONAL
NC	3400011	Medicaid
NC	CA1796	Other	MEDICARE RAILROAD
NC	00513	Other	BCBSNC
NC	235013	Other	MEDICARE PROFESSIONAL
NC	34750011	Other	MEDICAID SWINGBED
NC	411013849	Other	MEDICARE RAILROAD
NC	8000306	Other	MEDICAID CRNA
NC	8907673	Other	MEDICAID PROFESSIONAL
NC	C30677	Other	MEDICARE RAILROAD
NC	2612160	Other	MEDICARE CRNA
NC	014MX	Other	BCBSNC LABS
NC	07673	Other	BCBSNC PROFESSIONAL
NC	430001766	Other	MEDICARE RAILROAD
NC	07673	Other	BCBSNC PROFESSIONAL
NC	235013B	Other	MEDICARE PROFESSIONAL