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Contact Information

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
403 N STATE OF FRANKLIN RD
JOHNSON CITY, TN37604-6034
 Phone: 423-431-7047
 Fax: 423-979-0569
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Child & Adolescent Psychiatry

2084P0804X 86 Physician/Neuropsychiatry
Indicates primary specialty

NPI Profile & details for BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

NPI # 1326058272
LBN Legal business name BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Authorized official CARL KILGORE - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 08/09/2006
Last updated 03/29/2019 - About 7 years ago
Identifiers
NC Medicaid 5908711
TN Medicaid 3377132
VA Medicaid 1326058272
Other CA5744 RR MEDICARE
TN Other 801453000 MAGELLAN
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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