Provider Demographics
NPI:1194795013
Name:BLUE RIDGE MEDICAL TRANSPORT INC
Entity type:Organization
Organization Name:BLUE RIDGE MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:POE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-246-2768
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-0672
Mailing Address - Country:US
Mailing Address - Phone:336-246-2768
Mailing Address - Fax:336-246-9803
Practice Address - Street 1:223 MORPHEW LANE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-0672
Practice Address - Country:US
Practice Address - Phone:336-246-2768
Practice Address - Fax:336-246-9803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1398341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
495744OtherUMW
NC3406723Medicaid
0724WOtherBCBS
495744OtherUMW