Provider Demographics
NPI:1396915781
Name:BLUE RIDGE GASTROENTEROLOGY
Entity type:Organization
Organization Name:BLUE RIDGE GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-825-4004
Mailing Address - Street 1:1200 SUNSET LN STE 2111
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3376
Mailing Address - Country:US
Mailing Address - Phone:540-825-4004
Mailing Address - Fax:540-825-8980
Practice Address - Street 1:1200 SUNSET LN STE 2111
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3376
Practice Address - Country:US
Practice Address - Phone:540-825-4004
Practice Address - Fax:540-825-8980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty