Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG Infectious Disease ABG
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
16000 JOHNSTON MEMORIAL DR, SUITE 313B, ABINGDON, VA 24211-7664
(276) 258-3770
(276) 258-3785
Mailing address
16000 JOHNSTON MEMORIAL DR, SUITE 313B, ABINGDON, VA 24211-7664
(276) 258-3770
(276) 258-3785
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114308822
—
VA
01
—
622377400
DEPARTMENT OF LABOR
VA
05
—
Q013947
—
TN
Enumeration date
06/18/2015
Last updated
02/14/2017
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