Organization
BLUE RIDGE RADIOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE SNYDER (CREDENTIALING MANAGER)
(423) 301-6567
Entity
Organization
Contact information
Practice address
111 STEVENSWOOD DR, BRISTOL, TN 37620-7308
(423) 968-1144
(423) 968-3453
Mailing address
111 STEVENSWOOD DR, BRISTOL, TN 37620-7308
(423) 968-1144
(423) 968-3453
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023464700
BLACK LUNG
—
01
—
1521046
UMWA
—
01
—
242032
ANTHEM
VA
01
—
373437500
DOL
—
01
—
CD5029
PGBA (RR MEDICARE)
—
Enumeration date
08/26/2005
Last updated
07/30/2025
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