Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG NEUROSURG JC
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
408 N STATE OF FRANKLIN RD, SUITE 42, JOHNSON CITY, TN 37604-6089
(423) 431-2350
(423) 431-2372
Mailing address
408 N STATE OF FRANKLIN RD, SUITE 42, JOHNSON CITY, TN 37604-6089
(423) 431-2350
(423) 431-2372
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3377139
—
TN
Enumeration date
06/12/2006
Last updated
04/04/2012
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