Provider Demographics
NPI:1710211560
Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Other - Org Name:MCDOWELL MEDICAL ASSOCIATES, PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-652-8727
Mailing Address - Street 1:1860 SUGAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5565
Mailing Address - Country:US
Mailing Address - Phone:828-659-9703
Mailing Address - Fax:828-659-9357
Practice Address - Street 1:5920 US HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:NEBO
Practice Address - State:NC
Practice Address - Zip Code:28761-9565
Practice Address - Country:US
Practice Address - Phone:828-652-8727
Practice Address - Fax:828-652-8793
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02082OtherBLUE CROSS BLUE SHIELD OF NC
NC34D0947561OtherCLIA
NC690168LMedicaid
NC2344566Medicare PIN