Blue Ridge Medical Management Corporation

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Practice address

2300 Pavilion Dr
Kingsport, TN 37660-4622

Phone

(423) 392-5500

Fax

(423) 392-5597

NPI assigned

Sep 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

C. Steven Kilgore

Title

Senior Vice President

Phone

(423) 915-5185

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• DBA Indian Path Pavilion Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Evan Andrew Los, EVAN LOS, M.D.

  • Pediatric Endocrinology Physician
  • Johnson City, TN
  • NPI 1174842348
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1659475374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 PAVILION DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604622",
            "telephone_number": "423-392-5500",
            "fax_number": "423-392-5597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 PAVILION DR",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604622",
            "telephone_number": "423-392-5500",
            "fax_number": "423-392-5597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-12",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "C.",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "423-915-5185"
    },
    "taxonomies": [
        {
            "code": "2084A0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3716292",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Indian Path Pavilion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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

• Addiction Medicine (Psychiatry & Neurology) Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.