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Organization

BLUE RIDGE MEDICAL MANAGEMENT CORPORATION

Active
Other names
MSMG GEN SURG LEB
Organization subpart
No

Provider details

NPI number
Authorized official
MR. CARL STEVEN KILGORE (PRESIDENT)
(423) 915-5116
Entity
Organization

Contact information

Practice address
58 CARROLL STREET, STE 2, LEBANON, VA 24266-0000
(276) 883-8085
(276) 883-8090
Mailing address
PO BOX 3700, JOHNSON CITY, TN 37602-3700
(866) 397-1439
(423) 262-1373

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1437462025
VA
Enumeration date
07/23/2010
Last updated
10/29/2010
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