Provider Demographics
NPI:1922046820
Name:BLOWING ROCK MEDICAL CLINIC PR
Entity Type:Organization
Organization Name:BLOWING ROCK MEDICAL CLINIC PR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-295-3116
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BLOWING ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28605-0008
Mailing Address - Country:US
Mailing Address - Phone:828-295-3116
Mailing Address - Fax:828-295-4388
Practice Address - Street 1:366 CHESTNUT DRIVE
Practice Address - Street 2:
Practice Address - City:BLOWING ROCK
Practice Address - State:NC
Practice Address - Zip Code:28605-0008
Practice Address - Country:US
Practice Address - Phone:828-295-3116
Practice Address - Fax:828-295-4388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty