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Contact Information

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
16000 JOHNSTON MEMORIAL DR
SUITE 313
ABINGDON, VA24211-7664
 Phone: 276-258-3780
 Fax: 276-258-3776
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Gerontology

363LG0600X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

NPI # 1619263068
LBN Legal business name BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Authorized official CARL KILGORE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 06/23/2011
Last updated 03/29/2019 - About 7 years ago
Identifiers
VA License # 0024166234
VA License # 0101052144
TN Medicaid 1527119
VA Medicaid 1619263068
VA Other 622377200 DEPARTMENT OF LABOR
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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