# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** MSMG OB GYN MAR A
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114219805
- **Authorized official:** MR. CARL STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 915-5116

## Contact information

- **Practice address:** 1205 SNIDER ST, MARION, VA 24354-4221
- **Practice address phone:** (276) 783-2354
- **Practice address fax:** (276) 783-2754
- **Mailing address:** 1205 SNIDER ST, MARION, VA 24354-4221
- **Mailing address phone:** (276) 783-2354
- **Mailing address fax:** (276) 783-2754

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2011
- **Last updated:** 01/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1114219805 | — | VA |
| 01 | — | DT9105 | RR MEDICARE | VA |