Provider Demographics
NPI:1851413561
Name:BLOWING ROCK HOSPITAL
Entity Type:Organization
Organization Name:BLOWING ROCK HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP MEDICAL STAFF SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA-CPMSM
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:418 CHESTNUT DRIVE
Mailing Address - Street 2:P.O. BOX 148
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605
Mailing Address - Country:US
Mailing Address - Phone:828-295-3136
Mailing Address - Fax:828-295-4587
Practice Address - Street 1:418 CHESTNUT DRIVE
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605
Practice Address - Country:US
Practice Address - Phone:828-295-3136
Practice Address - Fax:828-295-4587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34148223336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3414822OtherNCPDP
NC02277OtherLICENSE