Look up the most recent NPI and PECOS records

Blue Ridge Medical Management Corp

Family Medicine

Allopathic & Osteopathic Physicians

1905 American Way, Kingsport, TN 37660-5882

PECOS Enrollment

Based on the most recent information from CMS, provider Blue Ridge Medical Management Corp does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1588326839
Provider Type
Organization
Full Name
Blue Ridge Medical Management Corp

Subpart
No
Enumeration Date
10/13/2021
Last Updated
10/13/2021

Contact Information

Practice Location

1905 American Way, Kingsport, TN 37660-5882

(423) 578-8451

(423) 230-8224

Mailing Location

509 Med Tech Pkwy Ste 100, Johnson City, TN 37604-2579

(423) 302-6565

Unlisted Fax

Authorized Official

Dover, Laraine (Director)

(423) 952-2124

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License Unlisted Issuer

Blue Ridge Medical Management Corp

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Hadley, Eric

Galletti, Christopher

Kauzlarich, Michael P

Jenkins, Rebecca A

Geer, Robert

Funke, Robert Harold

Blue Ridge Medical Management Corporation

Amadio, Patricia B.

Woodard, Jennifer Lynn

Tochev, Tihomir Ivanov