Blue Ridge Medical Management Corpoartion
Organization Active NPI Orthopaedic Surgery Physician · Elizabethton, TN
NPI 1336442649 · NPPES record last updated Mar 10, 2011
Key facts
- NPI
- 1336442649
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
- Practice address
- 1497 West Elk Ave
Suite 11
Elizabethton, TN 37643 - Phone
- (423) 542-7480
- Fax
- (423) 542-7485
- NPI assigned
- Dec 8, 2010
- Organization subpart
- No
Authorized official
- Name
- Carl S Kilgore
- Title
- President
- Phone
- (423) 915-5100
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| 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
Locations
1021 W Oakland Ave
Ste 310
Johnson City, TN 37604
Phone (423) 302-6565
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
1497 West Elk Ave
Suite 11
Elizabethton, TN 37643
Mailing address
1497 West Elk Ave
Suite 11
Elizabethton, TN 37643
Phone (423) 542-7480
Other names
- MSMG Ortho ELIZ
Other providers in Elizabethton, TN
- Jasmine Dare Blake
- John Paul Blakley
- George Wallace Blankenship Jr.
- Blue Ridge Medical Management
- Blue Ridge Medical Management C Orporation
- 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 Elizabethton, TN · Orthopaedic Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 10, 2011. 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.