Provider Demographics
NPI:1528324621
Name:BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC
Entity type:Organization
Organization Name:BLUE RIDGE ORTHOPAEDIC ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-347-9220
Mailing Address - Street 1:PO BOX 316
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-0316
Mailing Address - Country:US
Mailing Address - Phone:800-521-8065
Mailing Address - Fax:703-842-8416
Practice Address - Street 1:410 BELLE AIR LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-4368
Practice Address - Country:US
Practice Address - Phone:540-347-9220
Practice Address - Fax:540-347-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00617Medicare UPIN