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Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
DBA Indian Path Pavilion
Organization subpart
No
Provider details
NPI number
Authorized official
C. STEVEN KILGORE (SENIOR VICE PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 392-5500
(423) 392-5597
Mailing address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 392-5500
(423) 392-5597
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
NULL
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
Other
Enumeration date
09/12/2006
Last updated
09/11/2025
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