Blue Ridge Medical Management Corporation
Organization Active NPI Urology Physician · Marion, VA
NPI 1386936078 · NPPES record last updated May 2, 2025
Key facts
- NPI
- 1386936078
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 1201 Snider St
Marion, VA 24354-4221 - Phone
- (276) 783-5400
- Fax
- (276) 783-5521
- NPI assigned
- May 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Carl Steven Kilgore
- Title
- President
- Phone
- (423) 302-3051
Corporate family (same tax ID) 20
Practitioners 2
-
Jordan Burke, PA
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
- Tax ID family
- Kingsport Internal Medi
Locations
1201 Snider St
Marion, VA 24354
Phone (276) 783-5400
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
1201 Snider St
Marion, VA 24354-4221
Mailing address
1201 Snider St
Marion, VA 24354-4221
Phone (276) 783-5400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DF7910 | Other | VA | RAILROAD MEDICARE |
| 1386936078 | Medicaid | VA |
Other names
- Ballad Health Medical Associates
- MSMG UROLOGY MAR
- BHMA Urology Marion
Other providers in Marion, VA
- 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
- Blue Ridge Medical Management Corporation
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.