Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG OB GYN MAR A
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
1205 SNIDER ST, MARION, VA 24354-4221
(276) 783-2354
(276) 783-2754
Mailing address
1205 SNIDER ST, MARION, VA 24354-4221
(276) 783-2354
(276) 783-2754
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114219805
—
VA
01
—
DT9105
RR MEDICARE
VA
Enumeration date
05/12/2011
Last updated
01/18/2016
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