Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG GEN SURG ELIZ A
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
1503 W ELK AVE, SUITE 8, ELIZABETHTON, TN 37643-2876
(423) 543-8619
(423) 543-5133
Mailing address
1503 W ELK AVE, SUITE 8, ELIZABETHTON, TN 37643-2876
(423) 543-8619
(423) 543-5133
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1516167
—
TN
Enumeration date
05/27/2009
Last updated
10/26/2010
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