Active NPI
Blue Ridge Medical Management Corporation
Doing business as MSMG Gen Surg Eliz a
- Specialist
- Elizabethton, TN
National Provider Identifier
1073748539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Doing business as
- MSMG Gen Surg Eliz a
- Practice address
- 1503 W Elk Ave
Suite 8
Elizabethton, TN 37643-2876 - Phone
- (423) 543-8619
- Fax
- (423) 543-5133
- NPI assigned
- May 27, 2009
- Last updated
- Oct 26, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Carl Steven Kilgore
- Title
- President
- Phone
- (423) 915-5100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
1503 W Elk Ave
Suite 8
Elizabethton, TN 37643-2876
Mailing address
1503 W Elk Ave
Suite 8
Elizabethton, TN 37643-2876
Phone (423) 543-8619
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1516167 | Medicaid | TN |
Other names 1
- MSMG GEN SURG ELIZ A
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000996 | TN | Part B Supplier - Clinic/Group Practice | 9739099441 |
Receives reassigned benefits from 562 practitioners This NPI is an additional NPI on the enrollment Practice locations: Johnson City, TN; Kingsport, TN; Mountain City, TN; Elizabethton, TN; Erwin, TN; Greeneville, TN |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1243382400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1288051200000",
"number": "1073748539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1503 W ELK AVE",
"address_2": "SUITE 8",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376432876",
"telephone_number": "423-543-8619",
"fax_number": "423-543-5133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1503 W ELK AVE",
"address_2": "SUITE 8",
"city": "ELIZABETHTON",
"state": "TN",
"postal_code": "376432876",
"telephone_number": "423-543-8619",
"fax_number": "423-543-5133"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2009-05-27",
"last_updated": "2010-10-26",
"status": "A",
"authorized_official_last_name": "KILGORE",
"authorized_official_first_name": "CARL",
"authorized_official_middle_name": "STEVEN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "423-915-5100"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1516167",
"state": "TN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MSMG GEN SURG ELIZ A",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Elizabethton, TN
- John Paul Blakley, FNP-C
- George Wallace Blankenship Jr., PHARMD, MBA
- Blue Ridge Medical Management (Regional Cancer Center At SSH)
- Blue Ridge Medical Management C Orporation (MSMG Im Eliz)
- Blue Ridge Medical Management Corpoartion (MSMG Ortho ELIZ)
- Blue Ridge Medical Management Corporation (MSMG Gen Surg Eliz B)
- Blue Ridge Medical Management Corporation (First Assist Urgent Care)
- Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
- Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)
- Blue Ridge Medical Management Corporation (Regional Cancer Center at Sycamore Shoals Hospital)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.