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Organization

BROAD RIVER AREA MEDICAL AND AESTHETICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
TIMOTHY D. GREEN PA (OWNER/PA)
(828) 657-5722
Entity
Organization

Contact information

Practice address
245 OLD MAIN STREET, CLIFFSIDE, NC 28024-0275
(828) 657-5722
(828) 657-5738
Mailing address
PO BOX 275, 245 OLD MAIN ST, CLIFFSIDE, NC 28024-0275
(828) 657-5722
(828) 657-5738

Taxonomy

Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
363A00000X
Physician Assistant
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1177X
BCBS
05
891177X
NC
Enumeration date
06/16/2006
Last updated
02/04/2026
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