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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