Dba Indian Path Pavilion
LBN: Blue Ridge Medical Management Corporation
Dba Indian Path Pavilion is an health care organization with primary practice located at 2300 Pavilion Dr , Kingsport TN 37660-4622. The organization recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Addiction Medicine, Allopathic & Osteopathic Physicians / Psychiatry. Allopathic & Osteopathic Physicians / Addiction Medicine is the primary health care specialty.
Blue Ridge Medical Management Corporation can be contacted via phone (423) 392-5500, or through Kilgore, C. Steven via phone (423) 915-5185.
Contact Information
Primary practice address
2300 Pavilion Dr
Kingsport TN 37660-4622
Phone: (423) 392-5500
Fax: (423) 392-5597
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Addiction Medicine | 2084A0401X | ||
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X |
Profile Details
| NPI number | 1659475374 |
|---|---|
| LBN Legal business name | Blue Ridge Medical Management Corporation |
| DBA Doing business as | Dba Indian Path Pavilion |
| Authorized official | Kilgore, C. Steven |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Sep 12th, 2006 |
| Last updated | Aug 22nd, 2020 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659475374 | NPPES |
| Tennessee | MEDICAID | 3716292 |
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