Organization
BLUE RIDGE MEDICAL MANAGEMENT C ORPORATION
Active
Other names
MSMG IM ELIZ
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5185
Entity
Organization
Contact information
Practice address
1497 W ELK AVE, SUITE 20, ELIZABETHTON, TN 37643-2874
(423) 547-2762
(423) 542-8621
Mailing address
PO BOX 3700, JOHNSON CITY, TN 37602-3700
(886) 639-7143
(423) 262-1373
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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