Eagle Ridge Medical Center Co.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

EAGLE RIDGE MEDICAL CENTER CO.

Doing business as

Blue Ridge Medical Center

Practice address

1030 Chalet Suzanne Rd
Lake Wales, FL 33859-7760

Phone

(863) 679-1818

Fax

(863) 679-1097

NPI assigned

Apr 2, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Margaret Ellen Eastham, MD

Title

President

Phone

(863) 679-1818

Specialties & licenses 1

Addresses

Other names 1

• Blue Ridge Medical Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669592564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 CHALET SUZANNE RD",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338597760",
            "telephone_number": "863-679-1818",
            "fax_number": "863-679-1097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 CHALET SUZANNE RD",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338597760",
            "telephone_number": "863-679-1818",
            "fax_number": "863-679-1097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIDGE MEDICAL CENTER CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EASTHAM",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-679-1818",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Ridge Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Fresenai Ararso Duguma, PHARMD
• Catherine Roberts Duncan, DVM
• Samantha Nicole Durkin, OTR/L
• Dva Healthcare Renal Care, Inc.
• Chelsey Dziekiewicz, RPH
• Margaret Ellen Eastham, MD
• Lee Wichner Edelstein, MD
• Hannah P Edmondson
• Mona Elsarraj
• Emanuel Support Services, Inc

• Primary Care Clinic/Center in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.