Organization
BLUE RIDGE PODIATRY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN LARRY CLEMENTS D.P.M (PRESIDENT)
(540) 885-8891
Entity
Organization
Contact information
Practice address
390 S MAIN ST STE 103, ROCKY MOUNT, VA 24151-1767
(540) 483-7933
(540) 463-9454
Mailing address
PO BOX 4205, EDEN, NC 27289-4205
(336) 623-4545
(206) 333-1892
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
0103000371
VA
213E00000X
Podiatrist
Primary
0103000391
VA
213E00000X
Podiatrist
0103300877
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009301208
—
VA
05
—
009301283
—
VA
05
—
009301747
—
VA
01
—
0518620001
NSC STAUNTON LOCATION
VA
01
—
0518620002
NSC LEXINGTON LOCATION
VA
01
—
CM9184
RR MEDICARE GROUP
VA
Enumeration date
10/19/2005
Last updated
11/22/2010
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