Provider Demographics
NPI:1104912419
Name:BLUE RIDGE WOMEN'S CARE PA
Entity type:Organization
Organization Name:BLUE RIDGE WOMEN'S CARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHULER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-985-1799
Mailing Address - Street 1:112 SURGICAL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29672
Mailing Address - Country:US
Mailing Address - Phone:864-985-1799
Mailing Address - Fax:864-888-4108
Practice Address - Street 1:112 SURGICAL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-6654
Practice Address - Country:US
Practice Address - Phone:864-985-1799
Practice Address - Fax:864-888-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12365207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7585Medicare PIN