BLUE RIDGE MEDICAL MANAGEMENT CORPORATION (NPI# 1922574474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922574474 |
| 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 Ste 135b Johnson City TN 37604-6972 |
| Practice Telephone | 4234312350 |
| Practice Fax Number | 4234312372 |
| Mailing Telephone | 4234312350 |
| Mailing Fax Number | 4234312372 |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2019-03-29 |
| Authorized Official Name | CARL KILGORE (PRESIDENT) |
| Authorized Official Telephone | 4233023051 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Ballad Health Medical Associates | Doing Business As Name - Organization |
| BHMA Neurology OP Johnson City | Other Name - Individual/Organization |
| MSMG Neurology OPJohnson 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 STE 135B |
| City | JOHNSON CITY |
| State | TN |
| Zip Code | 37604-6972 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194958215 | Tanzila Shams Kulman | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604 | 2009-08-24 |
| 1104433846 | Caroline Rhea Perry | Nurse Practitioner | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604-6972 | 2020-09-27 |
| 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 | 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 |
|---|---|---|---|---|
| 1194958215 | Tanzila Shams Kulman | Psychiatry & Neurology | 410 N State of Franklin Rd Ste 135b, Johnson City, TN 37604 | 2009-08-24 |
| 1730387036 | Ray Wallace Mettetal Jr. | Psychiatry & Neurology | 303 E 11th Ave, Johnson City, TN 37601-3932 | 2007-07-07 |
| 1942310149 | Pamela J. Costello, Md, PC | Psychiatry & Neurology | 3915 Bristol Hwy Ste 103, Johnson City, TN 37601-1400 | 2006-08-30 |
| 1457365876 | Pamela J Costello | Psychiatry & Neurology | 3915 Bristol Hwy Ste 301, Johnson City, TN 37601-1403 | 2006-07-28 |
| 1992750673 | Yi Annette Huang | Psychiatry & Neurology | 105 Woodlawn Drive, Johnson City, TN 37604-5978 | 2006-05-23 |
| 1245213545 | Nathaniel Robb Whaley | Psychiatry & Neurology | 1321 Sunset Drive, Suite 11, Johnson City, TN 37604-7902 | 2005-11-22 |
| 1205830536 | Fernando Bendfeldt | Psychiatry & Neurology | 101 Med Tech Pkwy, Ste 407, Johnson City, TN 37604-4000 | 2005-05-23 |
| 1265987325 | Upstate University Clinical Campus Medical Group At Binghamton, Inc. | Psychiatry & Neurology | 46 Harrison St, Johnson City, NY 13790-2120 | 2016-08-18 |
| 1659776375 | Blue Ridge Medical Management Corporation | Psychiatry & Neurology | 410 N State of Franklin Rd, Suite 135, Johnson City, TN 37604-6971 | 2014-10-23 |
| 1548503642 | Derek Y Yuan | Psychiatry & Neurology | 52 Harrison St Fl 2, Johnson City, NY 13790-2120 | 2013-03-27 |
| Find all providers in JOHNSON CITY | ||||
| 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.