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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
DBA MSMG FP ELIZ
Organization subpart
No
Provider details
NPI number
Authorized official
C STEVEN KILGORE (SENIOR VICE PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
305 LAWSON AVE, ELIZABETHTON, TN 37643-2926
(423) 543-5600
(423) 543-5610
Mailing address
305 LAWSON AVE, ELIZABETHTON, TN 37643-2926
(423) 543-5600
(423) 543-5610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3719386
—
TN
Enumeration date
07/01/2006
Last updated
03/10/2011
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