BLUE RIDGE MEDICAL MANAGEMENT (NPI# 1790167351) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790167351 |
| Entity Type | Organization |
| Organization Name | BLUE RIDGE MEDICAL MANAGEMENT |
| Other Organization Name | BALLAD HEALTH MEDICAL ASSOCIATES |
| Practice Address |
58 Carroll Street Suite 2d Lebanon VA 24266 |
| Practice Telephone | 2768838091 |
| Practice Fax Number | 2768838090 |
| Mailing Telephone | 2768838091 |
| Mailing Fax Number | 2768838090 |
| Enumeration Date | 2015-06-19 |
| Last Update Date | 2019-03-29 |
| 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 | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | DEPARTMENT OF LABOR | 020487828 | 01 |
| VA | 1790167351 | 05 |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA General Surgery Lebanon | Other Name - Individual/Organization |
| MSMG General Surgery LEB | 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 |
| 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 |
| 1063819720 | Blue Ridge Medical Management | Surgery | 98 15th St Nw, Suite 201b, Norton, VA 24273-1600 | 2014-11-24 |
| 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 |
58 CARROLL STREET SUITE 2D |
| City | LEBANON |
| State | VA |
| Zip Code | 24266 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922003730 | Russell County Medical Center, Inc | General Acute Care Hospital | 58 Carroll Street, Lebanon, VA 24266 | 2005-06-17 |
| 1104321405 | Amanda Elizabeth Loughlin | Nurse Practitioner | 58 Carroll Street, Lebanon, VA 24266 | 2018-03-28 |
| 1659897569 | Ashley Jane Jenkins | Nurse Practitioner | 58 Carroll Street, Suite 4, Lebanon, VA 24266 | 2017-08-22 |
| 1689043952 | Kelsey Wise Mccoy | Physician Assistant | 58 Carroll Street, Lebanon, VA 24266 | 2015-09-17 |
| 1407282098 | Meeradevi Sudarsanan | Nurse Practitioner | 58 Carroll Street, Suite 2, Lebanon, VA 24266 | 2013-09-16 |
| 1750690087 | Appalachian Emergency Physicians | Emergency Medicine | 58 Carroll Street, Lebanon, VA 24266-0001 | 2010-10-05 |
| 1437462025 | Blue Ridge Medical Management Corporation | Surgery | 58 Carroll Street, Ste 2, Lebanon, VA 24266-0000 | 2010-07-23 |
| 1073782900 | Mountain States Health Alliance | Anesthesiology | 58 Carroll Street, Lebanon, VA 24266-4510 | 2008-02-25 |
| 1972771236 | Mountain States Health Alliance | Anesthesiology | 58 Carroll Street, Lebanon, VA 24266 | 2008-02-20 |
| 1871761726 | Mountain States Health Alliance | Emergency Medicine | 58 Carroll Street, Lebanon, VA 24266-4510 | 2008-02-13 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114541174 | Nextdoor Drug | Pharmacist | 932 W Main St, Lebanon, VA 24266 | 2020-06-04 |
| 1720638661 | Advanced Practice Primary Care, Pllc | Nurse Practitioner | 2336 Coal Tipple Hollow, Lebanon, VA 24266 | 2019-09-12 |
| 1962051763 | Best Life Physical Therapy Inc. | Physical Therapist | 383 Technology Park Drive, Lebanon, VA 24266 | 2019-09-05 |
| 1093361024 | Alexis Rae Carson | Psychologist | 84 Dr Lorraine C. Turner Dr. Russell County Public Scho, Lebanon, VA 24266 | 2019-08-15 |
| 1457821019 | Blue Ridge Medical Management Corporation | Internal Medicine | 71 S Flannagan Ave Suite 81, Lebanon, VA 24266 | 2018-11-27 |
| 1457867202 | Elizabeth Altizer Baker | Speech-Language Pathologist | 84 Lorraine C. Turner Dr., Russell County Public Schools, Lebanon, VA 24266 | 2017-12-15 |
| 1851805683 | Laura Hankins Vencill | Speech-Language Pathologist | Russell County Public Schools, 84 Lorraine C. Turner Dr., Lebanon, VA 24266 | 2017-12-01 |
| 1487168670 | Stacy Nichole Davis | Counselor | 78 Rogers St, Lebanon, VA 24266 | 2017-11-27 |
| 1568976751 | Kelly Elizabeth Smith | Counselor | 216 Gilmer Street, Lebanon, VA 24266 | 2017-11-27 |
| 1659883312 | Sara K Poole | Occupational Therapist | 408 Fields Ave., Lebanon, VA 24266 | 2017-11-02 |
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| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| 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 |
|---|---|---|---|---|
| 1720216898 | Kyle Ward | Surgery | 120 Hospital Dr Ste 200, Lebanon, MO 65536-9227 | 2009-06-29 |
| 1699943951 | Blue Ridge Medical Mangement Corporation | Surgery | 81 Carroll Street, Lebanon, VA 24266 | 2008-02-20 |
| 1386866853 | Raman Kumar | Surgery | 735 Norman Dr Ste 3, Lebanon, PA 17042-7559 | 2007-05-03 |
| 1194733832 | Lebanon Surgical Associates | Surgery | Carroll & Tate Sts., Suite 4, Lebanon, VA 24266 | 2006-08-04 |
| 1922028711 | Terry Wayne Shortridge | Surgery | 55 Twin Oaks, Suite C-1, Lebanon, OR 97355-2864 | 2006-07-21 |
| 1164451621 | Jimmy R Maneksha | Surgery | 125 Mascoma Street, Alice Peck Day Memorial Hospital, Lebanon, NH 03766 | 2006-06-30 |
| 1255383766 | Larimore C Warren | Surgery | 1405 W Baddour Pkwy, Suite 100, Lebanon, TN 37087-2567 | 2006-05-16 |
| 1174571863 | Barbara A. Klatchko, M.d., Ltd. | Surgery | 402 S 12th St, Lebanon, PA 17042-6617 | 2006-05-04 |
| 1215991443 | Kevin D Slentz | Surgery | 429 W Walnut St, Lebanon, KY 40033-1346 | 2006-04-14 |
| 1386612943 | Donald Duane Coker | Surgery | 229 South Fourth Street, Lebanon, PA 17042-1281 | 2006-03-09 |
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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.