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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG CVT KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
(423) 929-7393
(423) 929-1427
Mailing address
2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
(423) 929-7393
(423) 929-1427
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
NULL
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
06/25/2009
Last updated
10/27/2010
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