Blue Ridge Medical Management Corporation

Key facts

NPI: 1124472691
Entity type: Organization (NPI type 2)
Primary specialty: Obstetrics & Gynecology Physician 207V00000X
Legal business name: BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice address: 277 White St NE
Abingdon, VA 24210-2913
Phone: (276) 628-4335
Fax: (276) 628-3195
NPI assigned: Apr 20, 2016
Organization subpart: No

Authorized official

Name: Carl Steven Kilgore
Title: President
Phone: (423) 915-5121

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Meshell Alexzandria Stokes, M.D. Obstetrics & Gynecology Physician · Abingdon, VA · NPI 1538402946

NPD SINGLE SPECIALTY
Vitaly Gennadievich Nazarov, MD Internal Medicine Physician · Kingsport, TN · NPI 1760469084

NPD

Medicare participation

Medicare fee-for-service enrollment: Enrolled in VA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040715001336	VA	Part B Supplier - Clinic/Group Practice	9739099441	Receives reassigned benefits from 340 practitioners This NPI is an additional NPI on the enrollment Practice locations: Lebanon, VA; Marion, VA; Meadowview, VA; Norton, VA; Abingdon, VA; Rural Retreat, VA; Big Stone Gap, VA; Abington, VA

National Provider Directory

Locations

16000 Johnston Memorial Dr
Ste 200
Abingdon, VA 24211
Phone (276) 258-1000

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Obstetrics & Gynecology Physician Group: 193400000X SINGLE SPECIALTY GROUP	207V00000X		TN	Yes

Addresses

Primary practice location

277 White St NE
Abingdon, VA 24210-2913

Mailing address

277 White St NE
Abingdon, VA 24210-2913
Phone (276) 628-4335

Other identifiers

Identifier	Type	State	Issuer
Q021743	Medicaid	TN
1124472691	Medicaid	VA

Other names

MSMG OB GYN ABG Doing business as

Other providers in Abingdon, VA

All providers in Abingdon, VA · Obstetrics & Gynecology Physician in Virginia

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2017. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider 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.