Blue Ridge Medical Management Corporation

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Practice address

2000 Brookside Dr
7TH Floor Geriatric Psychic Unit
Kingsport, TN 37660-4627

Phone

(423) 857-7740

Fax

(423) 857-7711

NPI assigned

Sep 13, 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 1

Addresses

Other identifiers 1

Other names 1

• DBA Indian Path Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Locations

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659476992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 BROOKSIDE DR",
            "address_2": "7TH FLOOR GERIATRIC PSYCHIC UNIT",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604627",
            "telephone_number": "423-857-7740",
            "fax_number": "423-857-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 BROOKSIDE DR",
            "address_2": "7TH FLOOR GERIATRIC PSYCHIC UNIT",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376604627",
            "telephone_number": "423-857-7740",
            "fax_number": "423-857-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2020-08-22",
        "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": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3732722",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA Indian Path Medical Center",
            "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

• Psychiatry Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Psychiatry Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.