Organization
BLUE RIDGE MEDICAL MANAGEMENT
Active
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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