Organization
BLUE RIDGE HEALTHCARE MEDICAL GROUP, INC.
Active
Other names
Alan F. Jacks, MD, PA
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA MOLL (SVP-CFO)
(828) 580-5003
Entity
Organization
Contact information
Practice address
845 MALCOLM BOULEVARD, CONNELLY SPRINGS, NC 28612-8615
(828) 580-3555
(828) 874-2111
Mailing address
845 MALCOLM BOULEVARD, CONNELLY SPRINGS, NC 28612-8615
(828) 580-3555
(828) 874-2111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
969601640
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2327875
MEDICARE PTAN
NC
Enumeration date
12/02/2011
Last updated
02/06/2025
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