| Organization Name: | BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC. |
| NPI Number: | 1285735191 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBERT FRITTS (SVP/CFO) |
| Mailing Address: | 730 Malcolm Blvd Suite 150 Rutherford College |
| State: | NC US |
| Postal Code: | 28671 |
| Phone Number: | 8288798684 |
| Fax Number: | 8288798459 |
| NPI Enumeration Date: | 09/25/2006 |
| NPI Last Update Date: | 04/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |