Blue Ridge Medical Management Corporation

Primary specialty

Pulmonary Disease PhysicianTaxonomy code 207RP1001X

Legal business name

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Practice address

444 Clinchfield St
Unit 201a
Kingsport, TN 37660-3858

Phone

(423) 857-7650

Fax

(423) 857-7655

NPI assigned

Jun 11, 2014

Organization subpart

No

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

Authorized official

Name

Carl Steven Kilgore

Title

President / Ceo

Phone

(423) 915-5100

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• MSMG PULMONOLOGY of KINGSPORT A 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": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487030400000",
    "number": "1699188276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST",
            "address_2": "UNIT 201A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603858",
            "telephone_number": "423-857-7650",
            "fax_number": "423-857-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "444 CLINCHFIELD ST",
            "address_2": "UNIT 201A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603858",
            "telephone_number": "423-857-7650",
            "fax_number": "423-857-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2017-02-14",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "423-915-5100"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1699188276",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q009979",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MSMG PULMONOLOGY of KINGSPORT A",
            "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 Managgement Corporation

• Pulmonary Disease Physician in Kingsport, TN
• Providers in Kingsport, TN by specialty
• Pulmonary Disease Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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.