Organization
BLUE RIDGE MEDICAL MANAGEMENT
Active
Other names
MSMG Vascular Surgery JC
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT/CEO)
(423) 915-5185
Entity
Organization
Contact information
Practice address
310 N STATE OF FRANKLIN RD, SUITE 101B, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Mailing address
310 N STATE OF FRANKLIN RD, SUITE 101B, JOHNSON CITY, TN 37604-6008
(423) 929-7393
(423) 929-0872
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
48573
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09112
MEDICARE
VA
Enumeration date
01/22/2014
Last updated
02/27/2017
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