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Blue Ridge Medical Management Corporation

Organization Active NPI Otolaryngology Physician · Marion, VA

NPI 1811289580 · NPPES record last updated May 17, 2011

Key facts

NPI
1811289580
Entity type
Organization (NPI type 2)
Primary specialty
Otolaryngology Physician 207Y00000X
Legal business name
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice address
1205 Snider St
Marion, VA 24354-4221
Phone
(276) 783-2630
Fax
(276) 783-3516
NPI assigned
May 12, 2011
Organization subpart
No

Authorized official

Name
Mr. Carl Steven Kilgore
Title
President
Phone
(423) 915-5116

Practitioners 1

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Y00000X Yes

Addresses

Primary practice location

1205 Snider St
Marion, VA 24354-4221

Mailing address

1205 Snider St
Marion, VA 24354-4221
Phone (276) 783-2630

Other names

  • MSMG ENT MAR Doing business as

Other providers in Marion, VA

All providers in Marion, VA · Otolaryngology Physician in Virginia

Sources for this page

Verify at the official NPI Registry.