Blue Ridge Medical Management Corporation
Organization Active NPI Internal Medicine Physician · Elizabethton, TN
NPI 1376846683 · NPPES record last updated May 2, 2025
Key facts
- NPI
- 1376846683
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 1497 West Elk Ave
Ste 10
Elizabethton, TN 37643 - Phone
- (423) 542-7440
- Fax
- (423) 542-7445
- NPI assigned
- Dec 8, 2010
- Organization subpart
- No
Authorized official
- Name
- Carl S Kilgore
- Title
- President
- Phone
- (423) 302-3051
Corporate family (same tax ID) 24
Practitioners 4
-
Justin Alan Jones, D.O.
-
Cathy L Maine, F.N.P.
-
Ashley Ward, FNP
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
- Tax ID family
- Kingsport Internal Medi
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes | ||
| Surgery Physician |
208600000X |
Addresses
Primary practice location
1497 West Elk Ave
Ste 10
Elizabethton, TN 37643
Mailing address
1497 West Elk Ave
Ste 10
Elizabethton, TN 37643
Phone (423) 542-7440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5911815 | Medicaid | NC | |
| 1521769 | Medicaid | TN | |
| 622164600 | Other | TN | DEPARTMENT OF LABOR |
Other names
- Ballad Health Medical Associates
- MSMG Gen Surg ELIZ
- BHMA General Surgery Elizabethton
Other providers in Elizabethton, TN
- 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
- Blue Ridge Medical Management Corporation
All providers in Elizabethton, TN · Internal Medicine 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 May 2, 2025. 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.