Blue Ridge Medical Management Corporation
Organization Active NPI Orthopaedic Surgery Physician · Elizabethton, TN
NPI 1831100767 · NPPES record last updated Oct 26, 2010
Key facts
- NPI
- 1831100767
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 1503 W Elk Ave
Suite 3
Elizabethton, TN 37643-2876 - Phone
- (423) 542-3806
- Fax
- (423) 542-3814
- NPI assigned
- Aug 9, 2006
- Organization subpart
- No
Authorized official
- Name
- C Steven Kilgore
- Title
- Senior Vice President
- Phone
- (423) 915-5100
Practitioners 2
-
Constance Alexis Hardy, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031204000996 | TN | Part B Supplier - Clinic/Group Practice | 9739099441 |
Receives reassigned benefits from 562 practitioners This NPI is an additional NPI on the enrollment Practice locations: Johnson City, TN; Kingsport, TN; Mountain City, TN; Elizabethton, TN; Erwin, TN; Greeneville, TN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | |||
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
1503 W Elk Ave
Suite 3
Elizabethton, TN 37643-2876
Mailing address
1503 W Elk Ave
Suite 3
Elizabethton, TN 37643-2876
Phone (423) 542-3806
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3377133 | Medicaid | TN |
Other names
- MSMG ORTHO ELIZ
Other providers in Elizabethton, TN
- 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
- Grace Reddick Gerlock Boerma
- Heather Nicole Bolton
- Ashley Danielle Bowman
- Kathryn Sue Bowman
All providers in Elizabethton, TN · Orthopaedic Surgery Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2010. 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.