Blue Ridge Medical Management Corporation
Organization Active NPI Otolaryngology Physician · Rural Retreat, VA
NPI 1982998852 · NPPES record last updated Jun 8, 2011
Key facts
- NPI
- 1982998852
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Otolaryngology Physician 207Y00000X
- Legal business name
- BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
- Practice address
- 7021 W Lee Highway
Suite B
Rural Retreat, VA 24368-0000 - Phone
- (276) 686-3067
- Fax
- (276) 686-2051
- NPI assigned
- Jun 8, 2011
- Organization subpart
- No
Authorized official
- Name
- Carl Steven Kilgore
- Title
- President
- Phone
- (423) 915-5116
Practitioners 3
-
Phillip Connors, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician |
207Y00000X | Yes |
Addresses
Primary practice location
7021 W Lee Highway
Suite B
Rural Retreat, VA 24368-0000
Mailing address
7021 W Lee Highway
Suite B
Rural Retreat, VA 24368-0000
Phone (276) 686-3067
Other names
- MSMG ENT RURL
Other providers in Rural Retreat, VA
- 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
- Lily Mae Boyd
- Julie Lynn Coulsey
- Cplace Rural Retreat SNF, LLC
- Miranda Paige Davidson
- Dickenson Pharmacy PC
All providers in Rural Retreat, VA · Otolaryngology Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 8, 2011. 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.