Blue Ridge Medical Management Corpoartion
Psychiatry & Neurology, Psychiatry in Big Stone Gap, VA. Organization (NPI-2).
NPI number1417683095
StatusActive
Last updated in NPPESJun 30, 2023
Details
- NPI
- 1417683095
- Entity type
- Organization (NPI-2)
- Legal business name
- Blue Ridge Medical Management Corpoartion
- Organization subpart
- No
- Enumeration date
- Jul 27, 2022
- Certification date
- Jun 30, 2023
- Last updated
- Jun 30, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | – | – | Yes |
Practice location
1980 Holton Ave E Ste 103Big Stone Gap, VA 24219-3367
Phone 423-302-3480 · Fax 423-722-3009
Mailing address
509 Med Tech Pkwy Ste 100Johnson City, TN 37604-2579
Phone 423-302-6565
Authorized official
Patricia Tarte
Enrollment
4233026565
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