BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1659475374) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659475374 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT CORPORATION |
| Other Organization Name | DBA INDIAN PATH PAVILION |
| Practice Address |
2300 Pavilion Dr Kingsport TN 37660-4622 |
| Practice Telephone | 4233925500 |
| Practice Fax Number | 4233925597 |
| Mailing Telephone | 4233925500 |
| Mailing Fax Number | 4233925597 |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | C. STEVEN KILGORE (SENIOR VICE PRESIDENT) |
| Authorized Official Telephone | 4239155185 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2084A0401X |
Psychiatry & Neurology Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| X | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3716292 | 05 |
| Other Name | Type Code |
|---|---|
| DBA Indian Path Pavilion | 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 |
2300 PAVILION DR |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660-4622 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417956400 | Timothy James Sullivan Jr. | Psychiatry & Neurology | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2005-07-20 |
| 1902438849 | Tonya Jean Keen | Occupational Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2020-02-09 |
| 1669034682 | Victoria Gillenwater | Physical Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2019-06-29 |
| 1649833880 | Brandon Drew Seale | Physical Therapist | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2019-04-14 |
| 1770067415 | April Kuntz | Speech-Language Pathologist | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2018-09-19 |
| 1346739174 | Carson Leigh Ann Johnson | Occupational Therapist | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2018-05-07 |
| 1639670987 | Matthew David Donaldson | Occupational Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2018-02-22 |
| 1437661089 | Brooke Ashley Parton | Physical Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2017-11-03 |
| 1104350685 | Virginia Conkin | Physical Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2017-04-12 |
| 1427590322 | Kelsey Stout | Occupational Therapy Assistant | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2016-11-08 |
| Find all providers in the same location | ||||
| 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 | 2084A0401X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Medicine |
| A doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to obtain a Certificate of Added Qualifications in the field of Addiction Medicine |
| Notes: Source: American Osteopathic Board of Neurology and Psychiatry, 2007 [1/1/2008: definition added, source added; 7/1/2011: modified source] - Additional Resources: http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821039512 | Charles B Herrin | Psychiatry & Neurology | 2300 Pavilion Dr, Kingsport, TN 37660-4622 | 2006-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376180216 | Firstep, LLC | Psychiatry & Neurology | 3183 W. State St., Suite 1201, Bristol, TN 37620 | 2019-12-10 |
| 1538703038 | Scott Eric Balogh | Psychiatry & Neurology | 65 Germantown Court, Suite 203, Cordova, TN 38018 | 2019-10-29 |
| 1184190712 | Paul Michael Mccurry | Psychiatry & Neurology | 8100 Enchanted Grove Ln, Powell, TN 37849-6310 | 2018-10-22 |
| 1548757677 | Achieve Wellness Center | Psychiatry & Neurology | 3432 Lebanon Pike, Hermitage, TN 37076-2006 | 2018-04-14 |
| 1932511680 | Harold Embrack | Psychiatry & Neurology | 1005 Dr D. B. Todd Blvd., Nashville, TN 37208-3501 | 2014-05-29 |
| 1669746723 | Life Help Psychiatry & Coaching LLC | Psychiatry & Neurology | 3249 Homewood Dr, Memphis, TN 38128-4409 | 2012-03-06 |
| 1447402268 | Beacon Professional Services, Plc | Psychiatry & Neurology | 1240 Old Weisgarber Rd Ste B, Knoxville, TN 37909-2683 | 2008-10-13 |
| 1992825889 | Charles Roger Freed Jr. | Psychiatry & Neurology | 5515 Edmondson Pike, Suite 119-e, Nashville, TN 37211-5871 | 2007-04-02 |
| 1679623375 | Richard G. Farmer | Psychiatry & Neurology | 1355 B Lynnfield Road, Suite 158, Memphis, TN 38119 | 2007-01-12 |
| 1629160049 | Paul Ragan | Psychiatry & Neurology | 930 Professional Park Dr, Clarksville, TN 37040-5136 | 2006-09-30 |
| Find all providers with the same taxonomy | ||||
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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.