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Organization

RUTHERFORD EMERGENCY MEDICINE PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MIKE BRADY (ADMINISTRATOR FOR GROUP)
(828) 277-7772
Entity
Organization

Contact information

Practice address
288 S RIDGECREST AVE, RUTHERFORDTON, NC 28139-2838
(843) 237-3378
(843) 237-5073
Mailing address
PO BOX 75358, CHARLOTTE, NC 28275-0358
(843) 237-3378
(843) 237-5073

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
N/A
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011R2
BLUE CROSS BLUE SHIELD
NC
05
89011R2
NC
01
CH4865
RAILROAD MEDICARE
NC
Enumeration date
07/13/2006
Last updated
03/16/2009
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