| Organization Name: | BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC. |
| NPI Number: | 1083854251 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT FRITTS (SVP-CFO) |
| Mailing Address: | 352-b East Parker Road Morganton |
| State: | NC US |
| Postal Code: | 28655 |
| Phone Number: | 8284336410 |
| Fax Number: | 8284384779 |
| NPI Enumeration Date: | 03/02/2009 |
| NPI Last Update Date: | 04/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | 200301349 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |