BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1043688385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043688385 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
410 N State of Franklin Rd Suite 135b Johnson City TN 37604 |
| Practice Telephone | 4234314866 |
| Practice Fax Number | 4234312372 |
| Mailing Telephone | 4234314866 |
| Mailing Fax Number | 4234312372 |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2019-03-28 |
| Authorized Official Name | CARL STEVEN KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | Q014763 | 05 | |
| TN | RAILROAD MEDICARE | CA5744 | 01 |
| VA | 1043688385 | 05 | |
| TN | DEPARTMENT OF LABOR | 622480000 | 01 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Neuroendovascular Surgery Johnson City | Other Name - Individual/Organization |
| MSMG Neuroendovascular Johnson City | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588128755 | Blue Ridge Medical Management Corporation | Family Medicine | 2030 Temple Hill Rd Ste B, Erwin, TN 37650-8721 | 2019-01-22 |
| 1558831115 | Blue Ridge Medical Management Corporation | Internal Medicine | 404 Bemberg Rd, Elizabethton, TN 37643 | 2018-11-27 |
| 1457821019 | Blue Ridge Medical Management Corporation | Internal Medicine | 71 S Flannagan Ave Suite 81, Lebanon, VA 24266 | 2018-11-27 |
| 1255816252 | Blue Ridge Medical Management Corporation | Clinic/Center | 1901 S Shady St Ste A, Mountain City, TN 37683-2021 | 2018-09-26 |
| 1184105272 | Blue Ridge Medical Management Corporation | Ophthalmology | 410 N State of Franklin Rd Ste 130b, Johnson City, TN 37604-6972 | 2018-08-27 |
| 1841770864 | Blue Ridge Medical Management Corporation | Pediatrics | 408 N State of Franklin Rd Ste 31g, Johnson City, TN 37604-6088 | 2018-08-20 |
| 1568958775 | Blue Ridge Medical Management Corporation | Urology | 408 N State of Franklin Rd Ste 31f, Johnson City, TN 37604-6088 | 2018-07-11 |
| 1477055317 | Blue Ridge Medical Management Corporation | Urology | 16000 Johnston Memorial Dr Ste 309, Abingdon, VA 24211-7664 | 2018-03-07 |
| 1669903803 | Blue Ridge Medical Management Corporation | Internal Medicine | 1497 W Elk Ave Ste 22b, Elizabethton, TN 37643-2896 | 2017-03-21 |
| 1245771757 | Blue Ridge Medical Management Corporation | Internal Medicine | 1410 Park Ave Nw, Norton, VA 24273 | 2017-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION | 303 Med Tech Parkway, Johnson City, Tennessee 37604 |
| North Carolina Corporations | Blue Ridge Medical Management Corporation | 160 Mine Lake Ct Ste 200, Raleigh, NC 27615 |
| Street Address |
410 N STATE OF FRANKLIN RD SUITE 135B |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346248028 | Brian Mason | Radiology | 410 N State of Franklin Rd, Suite 135b, Johnson City, TN 37604-6971 | 2005-07-07 |
| 1356880199 | Shriners Hospitals for Children | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2017-02-13 |
| 1659776375 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604-6971 | 2014-10-23 |
| 1003152307 | Blue Ridge Medical Management Corporation | Neurological Surgery | 410 N State of Franklin Rd, Suite 120, Johnson City, TN 37604-6971 | 2012-12-14 |
| 1134497787 | Ted Allan White | Nurse Practitioner | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2011-12-12 |
| 1518266725 | William Andrew Crabtree | Physician Assistant | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2011-03-28 |
| 1093016024 | Blue Ridge Medical Management Corporation | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2010-11-08 |
| 1245559236 | Tanzid Shams | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604 | 2010-05-31 |
| 1275867715 | Brandon Green | Orthopaedic Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2009-10-01 |
| 1801022975 | John Benjamin Yarger | Surgery | 410 N State of Franklin Rd, Suite 130, Johnson City, TN 37604-6971 | 2009-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560707 | Brant Logan Nickens | Physical Therapist | 809 Lamont St and Veterans Way, Johnson City, TN 37604 | 2020-08-26 |
| 1952911562 | David Sandlin Hobbs | Pharmacist | Lamont St &, Veterans Way, Johnson City, Tn 37604, Johnson City, TN 37604 | 2020-08-07 |
| 1528688272 | Whitney Marie Ward | Physical Therapist | Lamont Street and Veterans Way, Johnson City, TN 37604 | 2020-04-23 |
| 1861050015 | Akesh Thomas | Student in an Organized Health Care Education/Training Program | Johnson City Medical Center, 400 N State of Franklin Rd, Johnson City, TN 37604 | 2019-06-03 |
| 1336629021 | Medical Education Assistance Corporation | Clinic/Center | 820 W Market St, Johnson City, TN 37604 | 2018-08-21 |
| 1093208951 | Lauren Tiffany Hayden | Physician Assistant | 403 N State of Franklin Rd Woodridge Hospital, Johnson City, TN 37604 | 2018-06-14 |
| 1174014450 | Jerica Moore | Specialist/Technologist | 1041 Hamiltion Place Dr., Johnson City, TN 37604 | 2018-05-23 |
| 1053809442 | Syed Ghazanfar Hasan | Student in an Organized Health Care Education/Training Program | Etsu Psychiatry and Behavioral Sciences Department, 1276 Gilbreath Dr., Johnson City, TN 37604 | 2018-05-01 |
| 1699262485 | Sonia Kumari Oad | Student in an Organized Health Care Education/Training Program | 178 West Maple St, Johnson City, TN 37604 | 2018-04-17 |
| 1821519364 | Mahmoud El Iskandarani | Internal Medicine | 1084 W Oakland Avenue, 748, Johnson City, TN 37604 | 2017-07-06 |
| Find all providers in zip 37604 | ||||
| Taxonomy Code | 2085R0204X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Vascular & Interventional Radiology |
| A radiologist who diagnoses and treats diseases by various radiologic imaging modalities. These include fluoroscopy, digital radiography, computed tomography, sonography and magnetic resonance imaging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487277042 | Via Institutes Pllc | Radiology | 8886 Classic Dr, Memphis, TN 38125-8839 | 2020-05-18 |
| 1609334713 | Paul Wooten | Radiology | 1729 Curie St, Alcoa, TN 37701-1700 | 2019-03-07 |
| 1295112498 | David R Zielske | Radiology | 839 Treemont Ct, Nashville, TN 37220-1536 | 2015-04-27 |
| 1760820625 | John Dalton Braun | Radiology | 7600 Wolf River Blvd Ste 200, Germantown, TN 38138 | 2013-06-12 |
| 1942551270 | Sam J Williams IIi | Radiology | 1610 Shore View Ln, Hixson, TN 37343-4646 | 2012-09-26 |
| 1144485418 | Vijaykumar Agrawal | Radiology | 865 Jefferson Avenue Department of Radiology, F150 Chandler, Memphis, TN 38163-0001 | 2008-07-25 |
| 1780618942 | Tennessee Phlebology PC | Radiology | 9020 Overlook Blvd Ste 150, Brentwood, TN 37027-2727 | 2006-07-11 |
| 1104883966 | Jason Glen Funderburk | Radiology | 116 Concord Rd, Suite 500, Knoxville, TN 37934-2940 | 2006-04-27 |
| 1851865794 | Zeni Interventional Pllc | Radiology | 6126 Poplar Ave, Memphis, TN 38119-4710 | 2019-01-14 |
| 1841799707 | Southern Pain and Regenerative Medicine PC | Radiology | 176 Briarwood St Ste B, Camden, TN 38320-1456 | 2018-02-06 |
| Find all providers with the same taxonomy | ||||
| City | JOHNSON CITY |
| Zip Code | 37604 |
Please comment or provide details below to improve the information on BLUE RIDGE MEDICAL MANAGEMENT CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.