Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG CVT KPT
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
(423) 929-7393
(423) 929-1427
Mailing address
2205 PAVILION DR, SUITE 102, KINGSPORT, TN 37660-4641
(423) 929-7393
(423) 929-1427
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1515098
—
TN
Enumeration date
06/25/2009
Last updated
10/27/2010
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