Blue Ridge Medical Management Corpoartion
Organization Active NPI Psychiatry Physician · Big Stone Gap, VA
NPI 1417683095 · NPPES record last updated Jun 30, 2023
Key facts
- NPI
- 1417683095
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
- Practice address
- 1980 Holton Ave E Ste 103
Big Stone Gap, VA 24219-3367 - Phone
- (423) 302-3480
- Fax
- (423) 722-3009
- NPI assigned
- Jul 27, 2022
- Organization subpart
- No
Authorized official
- Name
- Patricia Tarte
- Title
- Enrollment
- Phone
- (423) 302-6565
Corporate family (same tax ID) 22
Practitioners 4
-
Kim Carter, LPC, LPCC, NCC
-
Ashley Galvez, NP
-
Terry Lee Westbrook, PA-C
-
Zachary Gamble, DO
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
509 Med Tech Pkwy
Ste 100
Johnson City, TN 37604
Phone (423) 302-6565
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician |
2084P0800X | Yes |
Addresses
Primary practice location
1980 Holton Ave E Ste 103
Big Stone Gap, VA 24219-3367
Mailing address
509 Med Tech Pkwy Ste 100
Johnson City, TN 37604-2579
Phone (423) 302-6565
Other providers in Big Stone Gap, VA
- Christopher Eugene Bishop
- Doris Jean Bishop
- Daphne Dawn Blanton
- Mark Lee Blanton
- Rachel Allison Bledsoe
- Judy Ann Bolling
- Rebecca Faith Bolling
- Susan Kay Bolling
- Troy Adam Boring II
- Robert Andrew Botts
All providers in Big Stone Gap, VA · Psychiatry 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 Jun 30, 2023. 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.