Blue Ridge Medical Management Corporation
Organization Active NPI Gastroenterology Physician · Marion, VA
NPI 1164966909 · NPPES record last updated Mar 28, 2019
Key facts
- NPI
- 1164966909
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 245 Medical Park Dr
Suite E
Marion, VA 24354-1100 - Phone
- (276) 258-3600
- Fax
- (276) 258-3605
- NPI assigned
- Dec 13, 2016
- Organization subpart
- No
Authorized official
- Name
- Carl Steven Kilgore
- Title
- President
- Phone
- (423) 302-3051
Practitioners 2
-
Paul Steven Modlinger, M.D.
-
Pushkas Gopalan, MD
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
100 15th St NW
Ste A
Norton, VA 24273
Phone (276) 439-1840
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician |
207RG0100X | Yes |
Addresses
Primary practice location
245 Medical Park Dr
Suite E
Marion, VA 24354-1100
Mailing address
245 Medical Park Dr
Suite E
Marion, VA 24354-1100
Phone (276) 258-3600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164966909 | Medicaid | VA |
Other names
- Ballad Health Medical Associates
- MSMG Gastroenterology MAR
- BHMA Gastroenterology Marion
Other providers in Marion, VA
- Blue Ridge Medical Management
- Blue Ridge Medical Management Corpoartion
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
- Blue Ridge Medical Management Corporation
All providers in Marion, VA · Gastroenterology 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 Mar 28, 2019. 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.