BLUE RIDGE MEDICAL MANAGEMENT (NPI# 1063819720) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063819720 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT |
| Other Organization Name | MSMG VAS SURG NOR |
| Practice Address |
98 15th St Nw Suite 201b Norton VA 24273-1600 |
| Practice Telephone | 2764391490 |
| Practice Fax Number | 2764391495 |
| Mailing Telephone | 2764391490 |
| Mailing Fax Number | 2764391495 |
| Enumeration Date | 2014-11-24 |
| Last Update Date | 2017-02-14 |
| Authorized Official Name | MR. CARL STEPHEN KILGORE (PRESIDENT/CEO) |
| Authorized Official Telephone | 4239155116 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
0101254593 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RAILROAD MEDICARE | DF7910 | 01 |
| VA | DEPARTMENT OF LABOR | 622968500 | 01 |
| Other Name | Type Code |
|---|---|
| MSMG VAS SURG NOR | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598141970 | Blue Ridge Medical Management | Internal Medicine | 245 Medical Park Dr, Marion, VA 24354-1100 | 2015-08-07 |
| 1790167351 | Blue Ridge Medical Management | Surgery | 58 Carroll Street, Suite 2d, Lebanon, VA 24266 | 2015-06-19 |
| 1689053753 | Blue Ridge Medical Management | Internal Medicine | 1497 W Elk Ave, Suite 20b, Elizabethton, TN 37643-2895 | 2015-05-22 |
| 1811380520 | Blue Ridge Medical Management | Surgery | 630 Oneega Ln, Suite D, Erwin, TN 37650-2197 | 2015-03-05 |
| 1295143378 | Blue Ridge Medical Management | Internal Medicine | 444 Clinchfield St, Unit 201b, Kingsport, TN 37660-3606 | 2014-08-01 |
| 1114340445 | Blue Ridge Medical Management | Surgery | 310 N State of Franklin Rd, Suite 101b, Johnson City, TN 37604-6008 | 2014-01-22 |
| 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 |
| New York State Corporations | BLUE RIDGE MEDICAL MANAGEMENT LLC | 2644 East 19th Street, Brooklyn, New York 11235 |
| Street Address |
98 15TH ST NW SUITE 201B |
| City | NORTON |
| State | VA |
| Zip Code | 24273-1600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194785832 | Parmod Kumar Sapra | Pediatrics | 98 15th St Nw, Suite 209, Norton, VA 24273-1600 | 2006-03-25 |
| 1043692767 | Norton Community Physicians Services LLC | Internal Medicine | 98 15th St Nw, Suite 202, Norton, VA 24273-1600 | 2015-06-19 |
| 1164867719 | Blue Ridge Medical Management Corporation | Internal Medicine | 98 15th St Nw, Suite 203, Norton, VA 24273-1600 | 2013-05-08 |
| 1568796860 | Tamy E. Perng, D.o., Inc. | Surgery | 98 15th St Nw, Suite 206, Norton, VA 24273-1600 | 2009-09-21 |
| 1639302151 | Elie Tony Nader | Internal Medicine | 98 15th St Nw, Ste 201a, Norton, VA 24273-1600 | 2009-09-01 |
| 1689854846 | Guedon Medical Clinic | Clinic/Center | 98 15th St Nw, Norton, VA 24273-1600 | 2007-11-05 |
| 1396805917 | Ronald Jay Klayton | Internal Medicine | 98 15th St Nw, Suite 104 A, Norton, VA 24273-1600 | 2006-12-12 |
| 1497857312 | Olivette A Guedon | Family Medicine | 98 15th St Nw, Norton, VA 24273-1600 | 2006-09-01 |
| 1265485585 | Felix Eugene Shepard Jr. | Urology | 98 15th St Nw, Building #2 Suite #207, Norton, VA 24273-1600 | 2006-05-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457978751 | Donald Arthur Olson | Family Medicine | 1900 Holten Ave E, Big Stone Gap, VA 24273 | 2020-07-02 |
| 1528696440 | Kristi Matthews | Occupational Therapist | 22 10th St Nw, Norton, VA 24273 | 2020-03-27 |
| 1851929772 | Julie Ann Hoffer Mullins | Physical Therapist | 22 10th Street N.w., Norton, VA 24273 | 2020-03-27 |
| 1053839977 | Vijay Kumar PC | Family Medicine | 610 Park Avenue Nw, Norton, VA 24273 | 2017-08-30 |
| 1407376312 | Jacob A Nysather | Internal Medicine | 100 15th Street, N.w., Norton, VA 24273 | 2017-06-21 |
| 1154854248 | Family Preservation Services, Inc | Community/Behavioral Health | 5338 Esserville Road, Norton, VA 24273 | 2017-04-06 |
| 1245771757 | Blue Ridge Medical Management Corporation | Internal Medicine | 1410 Park Ave Nw, Norton, VA 24273 | 2017-03-16 |
| 1821548413 | William Luke Alls | Internal Medicine | 96 15th St., Suite 106, Norton, VA 24273 | 2016-10-07 |
| 1073978383 | Stephen Souther | Counselor | 515 Park Avenue Sw, Norton, VA 24273 | 2015-12-31 |
| 1306251889 | Rafaqat Rashid | Internal Medicine | 100 15th Street N.w, Norton Community Hospital, Internal Medicine Residency, Norton, VA 24273 | 2014-06-24 |
| Find all providers in zip 24273 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124670930 | Usa Vein Clinics of Chantilly LLC | Surgery | 3914 Centreville Rd Ste 125, Chantilly, VA 20151-3289 | 2019-07-11 |
| 1285115998 | Sentara Medical Group | Surgery | 397 Little Neck Rd Ste 110, Virginia Beach, VA 23452-5774 | 2018-08-22 |
| 1629586417 | Sentara Medical Group | Surgery | 1051 Loftis Blvd Ste 210, Newport News, VA 23606-3069 | 2018-01-16 |
| 1942724620 | Sentara Medical Group | Surgery | 500 Sentara Cir Ste 100, Williamsburg, VA 23188-5727 | 2017-08-03 |
| 1972980761 | Carlos Jose Torres-medina | Surgery | 500 J Clyde Morris Blvd # 603, Newport News, VA 23601-1929 | 2015-04-30 |
| 1306280128 | Justin Marc Milligan | Surgery | 397 Little Neck Rd Ste 120, Virginia Beach, VA 23452-5774 | 2013-04-23 |
| 1578817938 | Clinch Valley Vascular Surgical Assoc., Pllc | Surgery | 6719 Gov. G.c. Peery Highway, Suite 2600, Richlands, VA 24641 | 2012-11-06 |
| 1346503463 | Mid Atlantic Vascular Holding, LLC | Surgery | 1415 Eastridge Rd, Richmond, VA 23229-5501 | 2012-06-22 |
| 1265791297 | Vascular Surgery Group | Surgery | 850 Chistensen Court, Great Falls, VA 22066 | 2012-05-11 |
| 1902122922 | Hao Duy Pham | Surgery | 6719 Governor Gc Peery Hwy Ste 2600, Richlands, VA 24641 | 2010-04-15 |
| 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.