Organization
BLUE RIDGE MEDICAL MANAGEMENT
Active
Other names
MSMG VAS SURG NOR
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEPHEN KILGORE (PRESIDENT/CEO)
(423) 915-5116
Entity
Organization
Contact information
Practice address
98 15TH ST NW, SUITE 201B, NORTON, VA 24273-1600
(276) 439-1490
(276) 439-1495
Mailing address
98 15TH ST NW, SUITE 201B, NORTON, VA 24273-1600
(276) 439-1490
(276) 439-1495
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
0101254593
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
622968500
DEPARTMENT OF LABOR
VA
01
—
DF7910
RAILROAD MEDICARE
VA
Enumeration date
11/24/2014
Last updated
02/14/2017
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