Provider Demographics
NPI:1417683095
Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Entity type:Organization
Organization Name:BLUE RIDGE MEDICAL MANAGEMENT CORPOARTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-302-6565
Mailing Address - Street 1:509 MED TECH PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2579
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:1980 HOLTON AVE E STE 103
Practice Address - Street 2:
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-3367
Practice Address - Country:US
Practice Address - Phone:423-302-3480
Practice Address - Fax:423-722-3009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty