Organization
BLUE RIDGE UROLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA DAVIS (DIRECTOR CBO)
(512) 314-4331
Entity
Organization
Contact information
Practice address
1301 CAPITAL OF TEXAS HIGHWAY, SUITE B200, AUSTIN, TX 78746-6574
(512) 314-4331
Mailing address
PO BOX 847324, DALLAS, TX 75284-7324
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary
—
—
Other
Enumeration date
06/11/2008
Last updated
08/15/2008
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