Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG HIMA FWCH
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5100
Entity
Organization
Contact information
Practice address
300 MED TECH PKWY, JOHNSON CITY, TN 37604-2277
(423) 431-1810
(423) 431-1811
Mailing address
509 MED TECH PKWY, SUITE 100, JOHNSON CITY, TN 37604-2578
(423) 302-6882
(423) 952-2147
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275851974
—
VA
05
—
1520040
—
TN
01
—
4344805
BLUECARE
TN
05
—
7100118880
—
KY
05
—
7100161370
—
KY
01
—
CA5744
RR MEDICARE
TN
Enumeration date
05/06/2010
Last updated
07/08/2015
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