Blue Ridge Medical Associates, PA
Organization Active NPI Family Medicine Physician · Landrum, SC
NPI 1588609366 · NPPES record last updated Nov 20, 2007
Key facts
- NPI
- 1588609366
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 12702 (SC)
- Legal business name
- BLUE RIDGE MEDICAL ASSOCIATES, PA
- Practice address
- 1504 E Rutherford St
Landrum, SC 29356-1416 - Phone
- (864) 457-4500
- Fax
- (864) 457-2195
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Thomas Irwin Dashiell Jr., MD
- Title
- President
- Phone
- (864) 457-4500
National Provider Directory
Locations
1504 E Rutherford St
Landrum, SC 29356
Phone (864) 457-4500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 12702 | SC | Yes |
Addresses
Primary practice location
1504 E Rutherford St
Landrum, SC 29356-1416
Mailing address
1504 E Rutherford St
Landrum, SC 29356-1416
Phone (864) 457-4500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP4059 | Medicaid | SC |
Other providers in Landrum, SC
- Holly Ackerman
- Joseph Samuel Aughtry
- Jessica J Blass
- Ellen Parris Boatwright
- Hailey Mullinax Branyon
- Kimberly Lynn Bridges
- Jordan Clifford Burnett
- Joanne Louise Cahill
All providers in Landrum, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.