Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG URO ABG A
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT/CEO)
(423) 915-5121
Entity
Organization
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, SUITE 312D, ABINGDON, VA 24211-7664
(276) 783-5400
(276) 783-5521
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 312D, ABINGDON, VA 24211-7664
(276) 783-5400
(276) 783-5521
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033593249
—
VA
01
—
623323300
DEPARTMENT OF LABOR
VA
Enumeration date
07/17/2015
Last updated
02/14/2017
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