BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1639441066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639441066 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | MSMG NEURO KPT |
| Practice Address |
2212 N John B Dennis Hwy Suite C Kingsport TN 37660-5894 |
| Practice Telephone | 4232243940 |
| Practice Fax Number | 4232243946 |
| Mailing Telephone | 4232243940 |
| Mailing Fax Number | 4232243946 |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2017-02-14 |
| Authorized Official Name | CARL S KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4239155100 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 1526970 | 05 | |
| TN | DEPARTMENT OF LABOR | 614862410 | 01 |
| VA | 1639441066 | 05 |
| Other Name | Type Code |
|---|---|
| MSMG Neuro KPT | 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 |
2212 N JOHN B DENNIS HWY SUITE C |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-5894 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013018431 | Christopher A Pendola | Psychiatry & Neurology | 2212 N John B Dennis Hwy, Suite C, Kingsport, TN 37660-5894 | 2006-09-26 |
| 1669661120 | Rodney J. Watson, M.d., Mpllc | Pediatrics | 2212 N John B Dennis Hwy, Kingsport, TN 37660-5894 | 2007-10-22 |
| 1366631723 | Arthur Garrett, M.d., Ph.d, Mpllc | Pediatrics | 2212 N John B Dennis Hwy, Kingsport, TN 37660-5894 | 2007-10-22 |
| 1811188436 | Diana Reinhardt | Pediatrics | 2212 N John B Dennis Hwy, Kingsport, TN 37660-5894 | 2007-08-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396868022 | Otakar Krcal | Psychiatry & Neurology | 8 Sheridan Sq, Ste 200, Kingsport, TN 37660-7479 | 2007-04-09 |
| 1013018431 | Christopher A Pendola | Psychiatry & Neurology | 2212 N John B Dennis Hwy, Suite C, Kingsport, TN 37660-5894 | 2006-09-26 |
| 1093701427 | Michael Dew | Psychiatry & Neurology | 8 Sheridan Sq Ste 200, Kingsport, TN 37660-7479 | 2005-09-21 |
| 1700015773 | Phillip E Justice | Psychiatry & Neurology | 1700 Pinebrook Dr, Ste. 2, Kingsport, TN 37660-4365 | 2009-07-10 |
| 1548304553 | Timothy F Himel | Psychiatry & Neurology | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2007-02-16 |
| 1457494833 | David K Garriott | Psychiatry & Neurology | 130 W Ravine Rd, Kingsport, TN 37660-3810 | 2007-02-15 |
| 1649322504 | Michael Jon Winsor | Psychiatry & Neurology | 130 W Ravine Rd, Kingsport, TN 37660-3837 | 2007-01-18 |
| 1093809188 | Robert Scott Macdonald | Psychiatry & Neurology | 914 Broad St, Suite 3a, Kingsport, TN 37660-3817 | 2006-10-03 |
| 1376644708 | Douglas A Wright | Psychiatry & Neurology | 914 Broad St, Suite 3a, Kingsport, TN 37660-3817 | 2006-09-26 |
| 1083715338 | Associated Neurologists of Kingsport | Psychiatry & Neurology | 8 Sheridan Sq Ste 200, Kingsport, TN 37660-7479 | 2006-09-26 |
| Find all providers in KINGSPORT | ||||
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| 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.