# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DBA MSMG FP ELIZ
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588693691
- **Authorized official:** C STEVEN KILGORE (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (423) 915-5185

## Contact information

- **Practice address:** 305 LAWSON AVE, ELIZABETHTON, TN 37643-2926
- **Practice address phone:** (423) 543-5600
- **Practice address fax:** (423) 543-5610
- **Mailing address:** 305 LAWSON AVE, ELIZABETHTON, TN 37643-2926
- **Mailing address phone:** (423) 543-5600
- **Mailing address fax:** (423) 543-5610

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/01/2006
- **Last updated:** 03/10/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 3719386 | — | TN |