Provider Demographics
NPI:1194943092
Name:BLUE RIDGE GENERAL SURGERY, PC
Entity type:Organization
Organization Name:BLUE RIDGE GENERAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-765-9933
Mailing Address - Street 1:8017 NINETEEN E HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:SPRUCE PINE
Mailing Address - State:NC
Mailing Address - Zip Code:28777
Mailing Address - Country:US
Mailing Address - Phone:828-765-9933
Mailing Address - Fax:
Practice Address - Street 1:8017 NINETEEN E HIGHWAY
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777
Practice Address - Country:US
Practice Address - Phone:828-765-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601047208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1709469OtherUNITED HEALTHCARE
NC03150OtherBCBS OF NC
NC8910603Medicaid
NC1709469OtherUNITED HEALTHCARE
NC8910603Medicaid