Provider Demographics
NPI:1891002374
Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP/CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-580-5003
Mailing Address - Street 1:1208 HICKORY BLVD SW STE 102
Mailing Address - Street 2:
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-6461
Mailing Address - Country:US
Mailing Address - Phone:828-991-4660
Mailing Address - Fax:828-991-4659
Practice Address - Street 1:1208 HICKORY BLVD SW STE 102
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-6461
Practice Address - Country:US
Practice Address - Phone:828-991-4660
Practice Address - Fax:828-991-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty