Provider Demographics
NPI:1295880557
Name:BLUE RIDGE SURGICAL ASSOC., PC
Entity type:Organization
Organization Name:BLUE RIDGE SURGICAL ASSOC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-236-6906
Mailing Address - Street 1:225 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2228
Mailing Address - Country:US
Mailing Address - Phone:276-236-6906
Mailing Address - Fax:276-236-7179
Practice Address - Street 1:225 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2228
Practice Address - Country:US
Practice Address - Phone:276-236-6906
Practice Address - Fax:276-236-7179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7374755Medicaid
VA7335288Medicaid
VA7374755Medicaid
VAH55508Medicare UPIN
VAB07034Medicare UPIN