# BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DBA Indian Path Pavilion
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659475374
- **Authorized official:** C. STEVEN KILGORE (SENIOR VICE PRESIDENT)
- **Authorized official phone:** (423) 915-5185

## Contact information

- **Practice address:** 2300 PAVILION DR, KINGSPORT, TN 37660-4622
- **Practice address phone:** (423) 392-5500
- **Practice address fax:** (423) 392-5597
- **Mailing address:** 2300 PAVILION DR, KINGSPORT, TN 37660-4622
- **Mailing address phone:** (423) 392-5500
- **Mailing address fax:** (423) 392-5597

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084A0401X | Addiction Medicine (Psychiatry & Neurology) Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 09/12/2006
- **Last updated:** 09/11/2025