Blue Ridge Medical Management Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Doing business as

MSMG Gen Surg Eliz B

Practice address

1503 W Elk Ave
Suite 3B
Elizabethton, TN 37643-2876

Phone

(423) 543-7168

Fax

(423) 542-3814

NPI assigned

Feb 26, 2009

Last updated

Oct 26, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Carl Steve Kilgore

Title

President

Phone

(423) 915-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MSMG GEN SURG ELIZ B Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Haytham Faruq Adada, MD

  • Pulmonary Disease Physician
  • Abingdon, VA
  • NPI 1336324896
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1235606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1083854384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 W ELK AVE",
            "address_2": "SUITE 3B",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432876",
            "telephone_number": "423-543-7168",
            "fax_number": "423-542-3814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 W ELK AVE",
            "address_2": "SUITE 3B",
            "city": "ELIZABETHTON",
            "state": "TN",
            "postal_code": "376432876",
            "telephone_number": "423-543-7168",
            "fax_number": "423-542-3814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-26",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-915-5100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750365433",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1513182",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG GEN SURG ELIZ B",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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 a)
• 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)
• Blue Ridge Medical Management Corporation (Ballad Health Medical Associates)

• Specialist in Elizabethton, TN
• Providers in Elizabethton, TN by specialty
• Specialist in Tennessee

• 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.

Verify at the official NPI Registry.