# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MSMG FM Elizabethton B
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629432828
- **Authorized official:** CARL STEVEN KILGORE (PRESIDENT)
- **Authorized official phone:** (423) 915-5121

## Contact information

- **Practice address:** 1497 W ELK AVE, SUITE 20, ELIZABETHTON, TN 37643-2895
- **Practice address phone:** (423) 542-7400
- **Practice address fax:** (423) 542-7405
- **Mailing address:** 1497 W ELK AVE, SUITE 20, ELIZABETHTON, TN 37643-2895
- **Mailing address phone:** (423) 542-7400
- **Mailing address fax:** (423) 542-7405

## Taxonomy

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

## Other

- **Enumeration date:** 04/13/2016
- **Last updated:** 10/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1629432828 | — | VA |
| 05 | — | Q020934 | — | TN |