BLUE RIDGE MEDICAL MANAGEMENT NPI 1114340445

NPI Information

NPI: 1114340445
Provider Name: BLUE RIDGE MEDICAL MANAGEMENT

Doing Business As: MSMG VASCULAR SURGERY JC

Classification: Surgery - 2086S0129X
Entity Type: Organization

Specialization: Vascular Surgery

Address:
310 N STATE OF FRANKLIN RD
SUITE 101B
JOHNSON CITY, TN
ZIP 37604
Phone: (423) 929-7393
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BLUE RIDGE MEDICAL MANAGEMENT is a vascular surgery surgery in Johnson City, TN. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. BLUE RIDGE MEDICAL MANAGEMENT NPI is 1114340445. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Msmg Vascular Surgery Jc.

The provider's business location address is:

310 N STATE OF FRANKLIN RD
SUITE 101B
JOHNSON CITY, TN
ZIP 37604-008
Phone: (423) 929-7393
Fax: (423) 929-0872

The provider's authorized official is Carl Steven Kilgore .
The authorized official title is President/ceo and has the following contact phone number (423) 915-5185.

The enumeration date for this NPI number is 1/22/2014 and was last updated on 2/27/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	48573	TENNESSEE	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C09112	OTHER	VIRGINIA	MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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