# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MSMG CVT KPT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144458332
- **Authorized official:** CARL STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 915-5100

## Contact information

- **Practice address:** 2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
- **Practice address phone:** (423) 929-7393
- **Practice address fax:** (423) 929-1427
- **Mailing address:** 2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
- **Mailing address phone:** (423) 929-7393
- **Mailing address fax:** (423) 929-1427

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | NULL | Yes |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |
| 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