Organization
BLUE RIDGE MEDICAL MANAGEMENT CORPORATION
Active
Other names
MSMG PEDS LEB
Organization subpart
No
Provider details
NPI number
Authorized official
CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization
Contact information
Practice address
344 OVERLOOK DR, LEBANON, VA 24266-3436
(276) 889-0201
(276) 889-0081
Mailing address
PO BOX 3700, JOHNSON CITY, TN 37602-3700
(866) 397-1439
(423) 262-1373
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295903565
—
VA
Enumeration date
02/20/2008
Last updated
10/29/2010
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