Provider Demographics
NPI:1730112475
Name:BLUE RIDGE FOOT AND ANKLE CLINIC PLC
Entity Type:Organization
Organization Name:BLUE RIDGE FOOT AND ANKLE CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:434-979-8116
Mailing Address - Street 1:887A RIO EAST CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8004
Mailing Address - Country:US
Mailing Address - Phone:434-979-8116
Mailing Address - Fax:434-979-8880
Practice Address - Street 1:887A RIO EAST CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8004
Practice Address - Country:US
Practice Address - Phone:434-979-8116
Practice Address - Fax:434-979-8880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103300932213ES0103X
VA0103000815213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010136016Medicaid
VA010135770Medicaid
VA010151503Medicaid
VA010193133Medicaid
VA5385000002Medicare NSC
VA010193133Medicaid
VA010136016Medicaid