Provider Demographics
NPI:1982380036
Name:BLUE RIDGE HEALTH LLC
Entity Type:Organization
Organization Name:BLUE RIDGE HEALTH LLC
Other - Org Name:BLUE RIDGE ENT HEAD NECK SKIN CANCER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTED MANAGING EMPLOYEE
Authorized Official - Prefix:MS
Authorized Official - First Name:TRUSHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-334-1856
Mailing Address - Street 1:3248 CLARKS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3722
Mailing Address - Country:US
Mailing Address - Phone:503-334-1856
Mailing Address - Fax:
Practice Address - Street 1:116 CLARKESVILLE PLZ
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-6216
Practice Address - Country:US
Practice Address - Phone:503-334-1856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty