Provider Demographics
NPI:1972671691
Name:BLUE RIDGE PEAKS INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:BLUE RIDGE PEAKS INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-687-7722
Mailing Address - Street 1:12 CANE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-9707
Mailing Address - Country:US
Mailing Address - Phone:828-687-7722
Mailing Address - Fax:828-687-7174
Practice Address - Street 1:12 CANE CREEK RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-9707
Practice Address - Country:US
Practice Address - Phone:828-687-7722
Practice Address - Fax:828-687-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC190440OtherMEDCOST
NC5708695OtherCIGNA HEALTHCARE
NC1421NOtherBCBS OF NC
NC=========OtherUNITED HEALTHCARE OF NC
NC1421NOtherBCBS OF NC
NC=========OtherFEDERAL TAX ID#