Organization
BLUE RIDGE CARDIOLOGY AND INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOMAS VYBIRAL M.D. (CEO)
(336) 526-7997
Entity
Organization
Contact information
Practice address
640 PARKWOOD MEDICAL PARK, ELKIN, NC 28621-2487
(336) 526-7997
(336) 526-3537
Mailing address
PO BOX 249, YADKINVILLE, NC 27055-0249
(336) 679-4963
(336) 679-2549
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
NC
207RC0000X
Cardiovascular Disease Physician
Primary
—
NC
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0286K
BCBS OF NC GROUP NUMBER
NC
01
—
21388
MEDCOST GROUP NUMBER
NC
05
—
890286K
—
NC
Enumeration date
02/07/2006
Last updated
08/23/2013
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