NPIMap

Organization Active NPI

Blue Ridge Medical Management Corporation

  • Urgent Care Clinic/Center
  • Kingsport, TN
National Provider Identifier
1982882379
Registry record updated Jul 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Practice address
1101 E Stone Dr
Suite 2
Kingsport, TN 37660-3384
Phone
(423) 246-7259
Fax
(423) 246-7205
NPI assigned
Feb 7, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2010

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

Authorized official

Name
Carl Steven Kilgore
Title
President
Phone
(423) 915-5234

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1101 E Stone Dr
Suite 2
Kingsport, TN 37660-3384

Mailing address

1101 E Stone Dr
Suite 2
Kingsport, TN 37660-3384
Phone (423) 246-7259

Other identifiers 1

IdentifierTypeStateIssuer
3735664MedicaidTN

Other names 1

  • First Assist Urgent Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Tax ID family
Kingsport Internal Medi70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1101 E Stone Dr
Ste 2
Kingsport, TN 37660
Phone (423) 224-1110

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1202342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278979200000",
    "number": "1982882379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E STONE DR",
            "address_2": "SUITE 2",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603384",
            "telephone_number": "423-246-7259",
            "fax_number": "423-246-7205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E STONE DR",
            "address_2": "SUITE 2",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603384",
            "telephone_number": "423-246-7259",
            "fax_number": "423-246-7205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE RIDGE MEDICAL MANAGEMENT CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-07",
        "last_updated": "2010-07-13",
        "status": "A",
        "authorized_official_last_name": "KILGORE",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "423-915-5234"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3735664",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Assist Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; 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.