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Contact Information

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
408 N STATE OF FRANKLIN RD
SUITE 31E
JOHNSON CITY, TN37604-6089
 Phone: 423-431-4946
 Fax: 423-431-4947
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Family

363LF0000X 50 Nurse Practitioner
 

Pediatric Gastroenterology

2080P0206X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

NPI # 1619349578
LBN Legal business name BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Authorized official CARL KILGORE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 10/30/2015
Last updated 05/02/2025 - More than a year ago
Identifiers
TN Medicaid Q020024
VA Medicaid 1619349578
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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