Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG GEN SURG MTN
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (CEO)
(423) 915-5116
Entity
Organization
Contact information
Practice address
1901 S SHADY ST, MOUNTAIN CITY, TN 37683-2021
(423) 727-1139
(423) 727-1173
Mailing address
1901 S SHADY ST, MOUNTAIN CITY, TN 37683-2021
(423) 727-1139
(423) 727-1173
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063783751
—
VA
05
—
1527050
—
TN
Enumeration date
01/26/2012
Last updated
02/14/2017
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